Donald R. Liberty, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

53466 Issued in CA

Practice address

4913 Golden Foothill Pkwy
El Dorado Hills, CA 95762

Phone

(916) 941-9860

Fax

(916) 941-7165

NPI assigned

Nov 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2015 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Donald R. Liberty, DDS, Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • El Dorado Hills, CA
  • NPI 1912281098
  NPD (past) Authorized official

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531958400000",
    "number": "1306924980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4913 GOLDEN FOOTHILL PKWY",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957629632",
            "telephone_number": "916-941-9860",
            "fax_number": "916-941-7165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4913 GOLDEN FOOTHILL PKWY",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "95762",
            "telephone_number": "916-941-9860",
            "fax_number": "916-941-7165"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11961 Heritage Oak Pl",
            "address_purpose": "LOCATION",
            "city": "Auburn",
            "state": "CA",
            "postal_code": "956032461",
            "country_code": "US",
            "telephone_number": "530-988-5878",
            "fax_number": "530-988-5254",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIBERTY",
        "first_name": "DONALD",
        "middle_name": "R.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2018-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "53466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Asya Monique Leslie, PHD
• Laura Kim Leslie, B.A.
• Ashley Lewis
• Catherine Lewis
• Ursula Lewis
• Geri Liebert, OT
• Raya Rain Liebscher, BEHAVIOR TECHNICIAN
• Raven Lighfoot
• Thomas Litawa, RT(R)
• Kristen Lloyd, COTA

• Oral and Maxillofacial Surgery (Dentist) in El Dorado Hills, CA
• Providers in El Dorado Hills, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.