Provider Demographics
NPI:1104865542
Name:LIBERATI, MARK EDMUND (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDMUND
Last Name:LIBERATI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-1503
Mailing Address - Country:US
Mailing Address - Phone:412-461-8255
Mailing Address - Fax:412-461-8256
Practice Address - Street 1:125 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1503
Practice Address - Country:US
Practice Address - Phone:412-461-8255
Practice Address - Fax:412-461-8256
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-024513-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist