# LIBERTY DENTAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** i-dentical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891023263
- **Authorized official:** DR. RAMON IVAN LUGO DMD, MBA (PRESIDENT)
- **Authorized official phone:** (215) 923-2233

## Contact information

- **Practice address:** 200 WALNUT STREET, PHILADELPHIA, PA 19106-3904
- **Practice address phone:** (215) 923-2233
- **Practice address fax:** (888) 608-7353
- **Mailing address:** 200 WALNUT ST., PHILADELPHIA, PA 19106-3904
- **Mailing address phone:** (215) 923-2233
- **Mailing address fax:** (888) 608-7353

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DS029647L | PA | Yes |

## Other

- **Enumeration date:** 11/24/2009
- **Last updated:** 11/24/2009