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General NPI Number Information
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NPI Number | 1003161191
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Entity Type | Individual
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Provider Name | MICHAEL BRIAN LIEBERMAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 35305 VALLEY FORGE DR
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-3216
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Country | US
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Telephone | 248-320-8540
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 BROADWAY APT 20B
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City | NEW YORK
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State | NY
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Zip | 10023-5043
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Country | US
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Telephone | 248-320-8540
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901021171
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 060287
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019029781
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS040221
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 021002603
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License Number State | IL
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