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General NPI Number Information
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NPI Number | 1265541965
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Entity Type | Individual
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Provider Name | GRANT M LISKE DDS
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 330 9TH ST
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City | RAMONA
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State | CA
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Zip | 92065-2321
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Country | US
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Telephone | 760-789-9500
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Fax | 760-789-5179
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Provider Business Mailing Address
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Address Line | 330 9TH STREET
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City | RAMONA
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State | CA
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Zip | 92065
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Country | US
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Telephone | 760-789-9500
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Fax | 760-789-5179
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 34871
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License Number State | CA
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