| Organization Name: | LIBERTY FAMILY DENTAL, LLC |
| NPI Number: | 1588821557 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTOPHER JOHN CASTER (MANAGER) |
| Mailing Address: | 2 Hawkeye Dr Suite 104 North Liberty |
| State: | IA US |
| Postal Code: | 523178200 |
| Phone Number: | 3196653773 |
| Fax Number: | |
| NPI Enumeration Date: | 05/19/2008 |
| NPI Last Update Date: | 05/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 07445 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |