Provider Demographics
NPI:1427206515
Name:LIBERTY DENTAL GROUP
Entity Type:Organization
Organization Name:LIBERTY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SURENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-933-7001
Mailing Address - Street 1:300 SCHUYLKILL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-5202
Mailing Address - Country:US
Mailing Address - Phone:610-933-7001
Mailing Address - Fax:610-983-9268
Practice Address - Street 1:300 SCHUYLKILL RD
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-5202
Practice Address - Country:US
Practice Address - Phone:610-933-7001
Practice Address - Fax:610-983-9268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026806L1223E0200X
PADS026473L1223G0001X
PADS0370321223G0001X
PADS027974L1223P0300X
PADS027665L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty