Individual provider Active NPI

Susan R Lieb, DDS

  • General Practice Dentistry
  • Farmington, CT
National Provider Identifier
1134466352
Registry record updated Feb 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
007194 Issued in CT
Practice address
263 Farmington Ave
Farmington, CT 06030-0001
Phone
(860) 679-2000
Fax
(860) 679-1899
NPI assigned
Jan 8, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2015

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 007194 CT Primary

Addresses

Primary practice location

263 Farmington Ave
Farmington, CT 06030-0001

Mailing address

263 Farmington Ave
Farmington, CT 06030-0001
Phone (860) 679-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150209000103 CT Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 5698090975

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
007194CTMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1357603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424649600000",
    "number": "1134466352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060300001",
            "telephone_number": "860-679-2000",
            "fax_number": "860-679-1899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060300001",
            "telephone_number": "860-679-2000",
            "fax_number": "860-679-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEB",
        "first_name": "SUSAN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-08",
        "last_updated": "2015-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "007194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.