Healthcare Provider Details

I. General information

NPI: 1700030541
Provider Name (Legal Business Name): ALAN M. LIEBERMAN, D.D.S., APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 BEACON AVE SUITE C
FREMONT CA
94538-1464
US

IV. Provider business mailing address

3805 BEACON AVE SUITE C
FREMONT CA
94538-1464
US

V. Phone/Fax

Practice location:
  • Phone: 510-796-8333
  • Fax:
Mailing address:
  • Phone: 510-796-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number23532
License Number StateCA

VIII. Authorized Official

Name: MRS. LEEVON JUNE LIEBERMAN
Title or Position: CORPORATE SECRETARY
Credential:
Phone: 510-796-8333