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General NPI Number Information
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NPI Number | 1972060606
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Entity Type | Individual
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Provider Name | GABRIELLE MORGAN LIEBERMAN
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Gender | Female
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 3915 E LINCOLN HWY
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City | DOWNINGTOWN
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State | PA
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Zip | 19335
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Country | US
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Telephone | 610-269-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 45 HOLLOW DR
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City | MALVERN
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State | PA
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Zip | 19355-9635
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Country | US
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Telephone | 516-458-6480
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | DS044111
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN1859077
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License Number State | MA
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