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General NPI Number Information
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NPI Number | 1912281098
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Entity Type | Organization
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Legal Business Name | DONALD R. LIBERTY, DDS, INC.
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Dates
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Enumeration Date | 10/06/2011
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Last Update Date | 10/06/2011
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Provider Practice Location Address
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Address Line | 4913 GOLDEN FOOTHILL PKWY
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-9636
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Country | US
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Telephone | 916-941-9860
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Fax | 916-941-7165
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Provider Business Mailing Address
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Address Line | 4913 GOLDEN FOOTHILL PKWY
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-9636
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Country | US
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Telephone | 916-941-9860
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Fax | 916-941-7165
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONALD ROBERT LIBERTY
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Credential | D.D.S.
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Telephone | 916-941-9860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 53466
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License Number State | CA
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