Provider Demographics
NPI:1225468572
Name:LIBERTY DENTAL OF MAPLEBROOK, LTD.
Entity Type:Organization
Organization Name:LIBERTY DENTAL OF MAPLEBROOK, LTD.
Other - Org Name:MAPLEBROOK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEHBAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAREEF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:331-588-1716
Mailing Address - Street 1:363 E BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-1415
Mailing Address - Country:US
Mailing Address - Phone:331-588-1716
Mailing Address - Fax:
Practice Address - Street 1:363 E BAILEY RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-1415
Practice Address - Country:US
Practice Address - Phone:331-588-1716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-24
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0288161223G0001X
IL019.0288521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty