MEDICARE: DR. MATTHEW JUSTIN LIAUTAUD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	44732	CA

General Provider Information

NPI Number	:	1568563021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW JUSTIN LIAUTAUD DDS

Provider Business Mailing Address
First Line	:	1909 PARKSIDE DR
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94519-2525
Country	:	US
Telephone Number	:	925-687-8250
Fax Number	:	925-687-8266

Provider Business Practice Location Address
First Line	:	1909 PARKSIDE DR
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94519-2525
Country	:	US
Telephone Number	:	925-687-8250
Fax Number	:	925-687-8266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	04/28/2011

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