Provider Demographics
NPI:1154685899
Name:GOLIBERSUCH, RYAN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:J
Last Name:GOLIBERSUCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3141 BEAUMONT CENTRE CIR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1960
Mailing Address - Country:US
Mailing Address - Phone:859-223-2120
Mailing Address - Fax:859-223-5276
Practice Address - Street 1:3141 BEAUMONT CENTRE CIR
Practice Address - Street 2:SUITE 300
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1960
Practice Address - Country:US
Practice Address - Phone:859-223-2120
Practice Address - Fax:859-223-5276
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY92211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice