Provider Demographics
NPI:1497169601
Name:LIBRATY, CHAD
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:LIBRATY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BISHOP AVE.
Mailing Address - Street 2:P.O. BOX 1277
Mailing Address - City:WILLSITON
Mailing Address - State:VT
Mailing Address - Zip Code:05495
Mailing Address - Country:US
Mailing Address - Phone:802-878-1170
Mailing Address - Fax:802-872-7139
Practice Address - Street 1:4750 SARAZEN DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-2346
Practice Address - Country:US
Practice Address - Phone:954-336-7729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0130276122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist