Active NPI
Jay E. Lieberman, D.M.D.
- General Practice Dentistry
- Park City, UT
National Provider Identifier
1245474428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5753918-9921
- Practice address
- 559 Woodside Ave
Park City, UT 84060-0513 - Phone
- (435) 649-0420
- NPI assigned
- May 1, 2009
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5753918-9921 | UT | Primary |
Addresses
Primary practice location
559 Woodside Ave
Park City, UT 84060-0513
Mailing address
PO Box 513
Park City, UT 84060-0513
Phone (425) 649-0420
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 |
|---|---|---|---|
| 5753918-9921 | UT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241136000000",
"number": "1245474428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 513",
"city": "PARK CITY",
"state": "UT",
"postal_code": "840600513",
"telephone_number": "425-649-0420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "559 WOODSIDE AVE",
"city": "PARK CITY",
"state": "UT",
"postal_code": "840600513",
"telephone_number": "435-649-0420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIEBERMAN",
"first_name": "JAY",
"middle_name": "E.",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-01",
"last_updated": "2009-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "UT",
"license": "5753918-9921",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.