Provider Demographics
NPI:1952644510
Name:GARY LIBERATI, DMD AND ASSOCIATES, PC
Entity Type:Organization
Organization Name:GARY LIBERATI, DMD AND ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LIBERATI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-795-5050
Mailing Address - Street 1:509 LONG RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-4365
Mailing Address - Country:US
Mailing Address - Phone:412-243-7117
Mailing Address - Fax:412-243-7173
Practice Address - Street 1:509 LONG RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-4365
Practice Address - Country:US
Practice Address - Phone:412-243-7117
Practice Address - Fax:412-243-7173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021430-L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6746920001Medicare NSC