Provider Demographics
NPI:1316453210
Name:LIBERTY PARK CHILDREN'S DENTISTRY
Entity type:Organization
Organization Name:LIBERTY PARK CHILDREN'S DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:QUYEN
Authorized Official - Middle Name:VU
Authorized Official - Last Name:YING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-403-5423
Mailing Address - Street 1:3304 MARLBORO DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1950 STONEGATE DR STE 100
Practice Address - Street 2:
Practice Address - City:VESTAVIA HLS
Practice Address - State:AL
Practice Address - Zip Code:35242-2525
Practice Address - Country:US
Practice Address - Phone:205-403-5423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6278C1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty