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General NPI Number Information
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NPI Number | 1205163029
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Entity Type | Organization
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Legal Business Name | GAIL GARDNER LIVENGOOD DDS, PA
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Dates
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Enumeration Date | 11/16/2009
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Last Update Date | 11/16/2009
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Provider Practice Location Address
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Address Line | 701 STATE PARK RD
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City | LOCKHART
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State | TX
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Zip | 78644
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Country | US
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Telephone | 512-398-3429
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Fax | 512-398-2233
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Provider Business Mailing Address
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Address Line | PO BOX 568
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City | LOCKHART
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State | TX
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Zip | 78644-0568
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Country | US
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Telephone | 512-398-3429
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Fax | 512-398-2233
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Authorized Official
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Title or Position | DENTIST
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Name | GAIL G LIVENGOOD
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Credential | D.D.S.
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Telephone | 512-398-3429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12566
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License Number State | TX
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