Nisa Keane Liberty, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

105107 Issued in CA

Practice address

8008 Folsom Auburn Rd
Folsom, CA 95630-1664

Phone

(916) 517-8188

NPI assigned

Jun 29, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1561766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1942862982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8008 FOLSOM AUBURN RD",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956301664",
            "telephone_number": "916-517-8188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8008 FOLSOM AUBURN RD",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956301664",
            "telephone_number": "916-517-8188"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2851 University Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543115855",
            "country_code": "US",
            "telephone_number": "920-431-2500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIBERTY",
        "first_name": "NISA",
        "middle_name": "KEANE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-29",
        "last_updated": "2020-11-17",
        "certification_date": "2020-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "105107",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Arthur Lewis, LMFT
• Ryan C Lewis, PHARM.D.
• Lexington Hills Senior Care LLC
• Eugene Rolluqui Leyble, MD
• Xiaoling Li
• Penelope Cadigan Libeu, M.D.
• Licensed in Home Healthcare, LLC
• Devora Lieberman
• Brigit Lorraine Moore Lim, M.P.T
• Daniel Lim

• General Practice Dentistry in Folsom, CA
• Providers in Folsom, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; 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.