NPIMap

Organization Active NPI

Liberty Dental, LLC

  • Dentist
  • Philadelphia, PA
National Provider Identifier
1891023263
Registry record updated Nov 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DS029647L Issued in PA
Legal business name
LIBERTY DENTAL, LLC
Doing business as
i-dentical
Practice address
200 Walnut Street
Philadelphia, PA 19106-3904
Phone
(215) 923-2233
Fax
(888) 608-7353
NPI assigned
Nov 24, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2009

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

Authorized official

Name
Dr. Ramon Ivan Lugo, DMD, MBANPI 1508190109
Title
President
Phone
(215) 923-2233

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X DS029647L PA Primary

Addresses

Primary practice location

200 Walnut Street
Philadelphia, PA 19106-3904

Mailing address

200 Walnut St.
Philadelphia, PA 19106-3904
Phone (215) 923-2233

Other names 1

  • i-dentical Doing business as

National Provider Directory

National Provider Directory

Locations

200 Walnut St
Philadelphia, PA 19106
Phone (215) 923-2233

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1259020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259020800000",
    "number": "1891023263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 WALNUT ST.",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191063904",
            "telephone_number": "215-923-2233",
            "fax_number": "888-608-7353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 WALNUT STREET",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191063904",
            "telephone_number": "215-923-2233",
            "fax_number": "888-608-7353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-24",
        "last_updated": "2009-11-24",
        "status": "A",
        "authorized_official_last_name": "LUGO",
        "authorized_official_first_name": "RAMON",
        "authorized_official_middle_name": "IVAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-923-2233",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MBA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS029647L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "i-dentical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 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.

Verify at the official NPI Registry.