Healthcare Provider Details

I. General information

NPI: 1710299193
Provider Name (Legal Business Name): DAVID MANUEL LIEBERMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 N WELLWOOD AVE
LINDENHURST NY
11757-1695
US

IV. Provider business mailing address

343 KILBURN RD S
GARDEN CITY NY
11530-5311
US

V. Phone/Fax

Practice location:
  • Phone: 631-225-1010
  • Fax: 631-225-1004
Mailing address:
  • Phone: 516-877-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number039653-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: