Provider Demographics
NPI:1447884903
Name:LIBERIA DENTAL CARE PLLC
Entity type:Organization
Organization Name:LIBERIA DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SRIDEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BABU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-483-9707
Mailing Address - Street 1:9528 LIBERIA AVE
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-1719
Mailing Address - Country:US
Mailing Address - Phone:703-969-5774
Mailing Address - Fax:571-379-5866
Practice Address - Street 1:9528 LIBERIA AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-1719
Practice Address - Country:US
Practice Address - Phone:703-969-5774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental