Organization
LIBERTY DENTAL, LLC
Active
Other names
i-dentical
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAMON IVAN LUGO DMD, MBA (PRESIDENT)
(215) 923-2233
Entity
Organization
Contact information
Practice address
200 WALNUT STREET, PHILADELPHIA, PA 19106-3904
(215) 923-2233
(888) 608-7353
Mailing address
200 WALNUT ST., PHILADELPHIA, PA 19106-3904
(215) 923-2233
(888) 608-7353
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS029647L
PA
Other
Enumeration date
11/24/2009
Last updated
11/24/2009
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