Liberty Dental, INC

NPI #1649516295 in Havana, Illinois

Provider Information

NPI Number: 1649516295
Entity Type: Organization
Organization Name: Liberty Dental, INC
Primary Specialty: Dentist - General Practice
Enumeration Date: Dec 28, 2012
Last Updated: Dec 28, 2012

Practice Location

Address: 112 W ADAMS ST
City: Havana
State: Illinois
ZIP Code: 62644-1337
Phone: (309) 543-6301

Authorized Official

Name: DR. AARON JAMES BLAKELY, D.M.D.
Title: PRESIDENT
Phone: (309) 543-6301

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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