Individual provider Active NPI

Joseph Michael De Libero, DDS

  • General Practice Dentistry
  • Mayfield HTS, OH
National Provider Identifier
1124074075
Registry record updated Mar 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
15136 Issued in OH
Practice address
5825 Landerbrook Dr
#122
Mayfield HTS, OH 44124-6532
Phone
(440) 461-0327
Fax
(440) 646-1327
NPI assigned
May 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 22, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 15136 OH Primary

Addresses

Primary practice location

5825 Landerbrook Dr
#122
Mayfield HTS, OH 44124-6532

Mailing address

5825 Landerbrook Dr
#122
Mayfield HTS, OH 44124-6532
Phone (440) 461-0327

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
15136OHMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269216000000",
    "number": "1124074075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5825 LANDERBROOK DR",
            "address_2": "#122",
            "city": "MAYFIELD HTS",
            "state": "OH",
            "postal_code": "441246532",
            "telephone_number": "440-461-0327",
            "fax_number": "440-646-1327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5825 LANDERBROOK DR",
            "address_2": "#122",
            "city": "MAYFIELD HTS",
            "state": "OH",
            "postal_code": "441246532",
            "telephone_number": "440-461-0327",
            "fax_number": "440-646-1327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LIBERO",
        "first_name": "JOSEPH",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2010-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "15136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mayfield HTS, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.