Healthcare Provider Details

I. General information

NPI: 1295364164
Provider Name (Legal Business Name): IAN LIEBERMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N YORK RD UNIT 11
HATBORO PA
19040-2617
US

IV. Provider business mailing address

1504 LONG POND DR
WARRINGTON PA
18976-1326
US

V. Phone/Fax

Practice location:
  • Phone: 215-674-2505
  • Fax:
Mailing address:
  • Phone: 516-477-6554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS044389
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number061857
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: