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General NPI Number Information
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NPI Number | 1912041062
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Entity Type | Organization
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Legal Business Name | MARYLAND ENDODONTIC GROUP, P.C.
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 02/23/2013
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Provider Practice Location Address
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Address Line | 22 W PADONIA RD SUITE C-244
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City | TIMONIUM
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State | MD
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Zip | 21093-2226
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Country | US
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Telephone | 410-252-3900
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Fax | 410-252-6051
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Provider Business Mailing Address
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Address Line | 22 W PADONIA RD SUITE C-244
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City | TIMONIUM
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State | MD
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Zip | 21093-2226
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Country | US
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Telephone | 410-252-3900
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Fax | 410-252-6051
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY ALAN LIEBERMAN
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Credential | D.D.S.
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Telephone | 410-252-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 6162
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License Number State | MD
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