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General NPI Number Information
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NPI Number | 1184325243
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Entity Type | Individual
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Provider Name | JACQUELINE D LIEBERMAN DMD
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Gender | Female
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Dates
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Enumeration Date | 03/15/2023
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 51 MEDICAL GROUP UNIT 2060
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City | APO
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State | AP
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Zip | 96278-2060
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Country | US
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Telephone | 850-883-8324
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Fax |
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Provider Business Mailing Address
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Address Line | 201 4TH ST S UNIT 841
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City | SAINT PETERSBURG
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State | FL
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Zip | 33701-4591
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Country | US
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Telephone | 610-955-2256
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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 | DS044070
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License Number State | PA
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