Kevin Joseph Liberko, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

D13662 Issued in MN

Practice address

5101 Vernon Ave S
Suite 1B
Edina, MN 55436-2172

Phone

(952) 920-9579

Fax

(952) 920-9298

NPI assigned

May 24, 2016

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

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Interlachen Dental Associates

  • General Practice Dentistry
  • Edina, MN
  • NPI 1437847654
  NPD Authorized official
• Interlachen Dental Associates

  • General Practice Dentistry
  • Edina, MN
  • NPI 1174600621
  NPD (past)

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

{
    "created_epoch": "1464048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464048000000",
    "number": "1962850545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 VERNON AVE S",
            "address_2": "SUITE 1B",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554362172",
            "telephone_number": "952-920-9579",
            "fax_number": "952-920-9298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5101 VERNON AVE S",
            "address_2": "SUITE 1B",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554362172",
            "telephone_number": "952-920-9579",
            "fax_number": "952-920-9298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBERKO",
        "first_name": "KEVIN",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-24",
        "last_updated": "2016-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsay Lewis, MD
• Lisa T Ley, PA-C
• Jason Ryan Leyendecker, AU.D.
• Courtney Marie Lezanic, MSW, LICSW
• Huagui Li, M.D.
• Liberty Care Services Inc
• Cindy S Libman, LICSW LMFT
• Licensed Dental Hygiene Care
• Brenda Liddle, SLP
• Lawrence S. Liebman, M.D.

• Dentist in Edina, MN
• Providers in Edina, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.