Active NPI
Gregory A Libby, D.D.S.
- Prosthodontics
- Phoenix, AZ
National Provider Identifier
1124123005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 5457
- Practice address
- 20950 N Tatum Blvd Ste 340
Phoenix, AZ 85050-4256 - Phone
- (480) 502-9833
- Fax
- (480) 502-9847
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 5457 | AZ | Primary |
Addresses
Primary practice location
20950 N Tatum Blvd Ste 340
Phoenix, AZ 85050-4256
Mailing address
20950 N Tatum Blvd Ste 340
Phoenix, AZ 85050-4256
Phone (480) 502-9833
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
| License | State | Type | Specialty |
|---|---|---|---|
| 5457 | AZ | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Desert Ridge Prosthodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Phoenix, AZ
- NPI 1477732436
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124123005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20950 N TATUM BLVD STE 340",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850504256",
"telephone_number": "480-502-9833",
"fax_number": "480-502-9847"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20950 N TATUM BLVD STE 340",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850504256",
"telephone_number": "480-502-9833",
"fax_number": "480-502-9847"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIBBY",
"first_name": "GREGORY",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "AZ",
"license": "5457",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.