Active NPI
Gregory R Liebsch, DDS
- General Practice Dentistry
- Blaine, MN
National Provider Identifier
1255442091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10305
- Practice address
- 10961 Club Parkway NE
Suite 240
Blaine, MN 55449 - Phone
- (763) 780-1292
- Fax
- (952) 967-5311
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 10305 | MN | Primary |
Addresses
Primary practice location
10961 Club Parkway NE
Suite 240
Blaine, MN 55449
Mailing address
PO Box 1309
Mail Code 21113a
Minneapolis, MN 55440-1309
Phone (952) 883-5151
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10305 | MN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Group Health, Inc. | Current | Accepting new patients | |
| Group Health, Inc. | General Practice | Past | Accepting new patients |
Locations
3930 Northwoods Dr
Saint Paul, MN 55112
Phone (651) 490-6775
Organizations & group practices 2
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.
-
- Multi-Specialty Clinic/Center
- Minneapolis, MN
- NPI 1710924683
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255442091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1309",
"address_2": "MAIL CODE 21113A",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554401309",
"telephone_number": "952-883-5151",
"fax_number": "952-883-5160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10961 CLUB PARKWAY NE",
"address_2": "SUITE 240",
"city": "BLAINE",
"state": "MN",
"postal_code": "55449",
"telephone_number": "763-780-1292",
"fax_number": "952-967-5311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIEBSCH",
"first_name": "GREGORY",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "10305",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blaine, MN
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.