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General NPI Number Information
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NPI Number | 1871044347
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Entity Type | Organization
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Legal Business Name | LIBERTY DENTAL CARE & DENTURES-LLC
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 7100 SENNET PL SUITE E
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City | LIBERTY TOWNSHP
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State | OH
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Zip | 45069-1794
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Country | US
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Telephone | 917-815-6369
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Fax |
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Provider Business Mailing Address
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Address Line | 7100 SENNET PLACE SUITE E
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City | LIBERTY TOWNSHIP
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State | OH
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Zip | 45069
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Country | US
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Telephone | 917-815-6369
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. KHALID RASHID CHAUDRY
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Credential | DDS
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Telephone | 917-815-6369
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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 | 30-022036
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License Number State | OH
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