Provider Demographics
NPI:1205163029
Name:GAIL GARDNER LIVENGOOD DDS, PA
Entity type:Organization
Organization Name:GAIL GARDNER LIVENGOOD DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:G
Authorized Official - Last Name:LIVENGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-398-3429
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:LOCKHART
Mailing Address - State:TX
Mailing Address - Zip Code:78644-0568
Mailing Address - Country:US
Mailing Address - Phone:512-398-3429
Mailing Address - Fax:512-398-2233
Practice Address - Street 1:701 STATE PARK RD
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644
Practice Address - Country:US
Practice Address - Phone:512-398-3429
Practice Address - Fax:512-398-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty