Provider Demographics
NPI:1194888271
Name:LIBERTY DENTAL ASSOCIATES
Entity type:Organization
Organization Name:LIBERTY DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CASTEEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:513-541-1941
Mailing Address - Street 1:11321 SPRINGFIELD PIKE
Mailing Address - Street 2:SPRINGWOOD PROFESSIONAL CENTER
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4201
Mailing Address - Country:US
Mailing Address - Phone:513-541-1941
Mailing Address - Fax:513-541-0773
Practice Address - Street 1:11321 SPRINGFIELD PIKE
Practice Address - Street 2:SPRINGWOOD PROFESSIONAL CENTER
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-4201
Practice Address - Country:US
Practice Address - Phone:513-541-1941
Practice Address - Fax:513-541-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH191421223G0001X
OH301115491223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty