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General NPI Number Information
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NPI Number | 1063198513
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Entity Type | Individual
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Provider Name | NICHOLAS LIBERTY DDS
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Gender | Male
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 2301 HOLMES ST
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City | KANSAS CITY
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State | MO
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Zip | 64108-2640
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Country | US
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Telephone | 215-503-6215
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Fax |
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Provider Business Mailing Address
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Address Line | 8008 FOLSOM AUBURN RD
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City | FOLSOM
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State | CA
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Zip | 95630-1664
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Country | US
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Telephone | 916-932-6037
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS044751
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | DS044751
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2023025122
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 110187
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License Number State | CA
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