Healthcare Provider Details

I. General information

NPI: 1902739410
Provider Name (Legal Business Name): KYLE LIEBERMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9419 COMMON BROOK RD STE 210
OWINGS MILLS MD
21117-7570
US

IV. Provider business mailing address

806 N 15TH ST UNIT 2
PHILADELPHIA PA
19130-2201
US

V. Phone/Fax

Practice location:
  • Phone: 443-394-2273
  • Fax:
Mailing address:
  • Phone: 443-280-1924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18680
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: