Healthcare Provider Details

I. General information

NPI: 1356836886
Provider Name (Legal Business Name): LAUREN SARIE LIEBMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 10/22/2022
Certification Date: 10/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E 35TH ST STE 1
NEW YORK NY
10016-3892
US

IV. Provider business mailing address

168 PLYMOUTH ST APT 3F
BROOKLYN NY
11201-1923
US

V. Phone/Fax

Practice location:
  • Phone: 212-736-3676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number060737
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: