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General NPI Number Information
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NPI Number | 1588821557
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Entity Type | Organization
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Legal Business Name | LIBERTY FAMILY DENTAL, LLC
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 2 HAWKEYE DR SUITE 104
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-8200
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Country | US
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Telephone | 319-665-3773
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Fax |
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Provider Business Mailing Address
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Address Line | 2 HAWKEYE DR SUITE 104
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City | NORTH LIBERTY
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State | IA
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Zip | 52317-8200
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. CHRISTOPHER JOHN CASTER
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Credential | D.D.S.
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Telephone | 319-665-3773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 07445
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License Number State | IA
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