Healthcare Provider Details

I. General information

NPI: 1700956737
Provider Name (Legal Business Name): MARTIN LIEBERMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 13TH AVE S
SEATTLE WA
98108-2706
US

IV. Provider business mailing address

905 SPRUCE ST STE. 300
SEATTLE WA
98104-2474
US

V. Phone/Fax

Practice location:
  • Phone: 206-548-3114
  • Fax: 206-762-6355
Mailing address:
  • Phone: 206-461-6935
  • Fax: 206-461-8382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00009213
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: