Healthcare Provider Details

I. General information

NPI: 1275626343
Provider Name (Legal Business Name): LAWRENCE LIEBERMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 MARKET ST
SADDLE BROOK NJ
07663
US

IV. Provider business mailing address

289 MARKET STREET
SADDLE BROOK NJ
07663
US

V. Phone/Fax

Practice location:
  • Phone: 201-843-7064
  • Fax: 201-843-4709
Mailing address:
  • Phone: 201-843-7064
  • Fax: 201-843-4709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number220100977400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: