Provider Demographics
NPI:1184852915
Name:LALIBERTE, REBECCA MARY (DMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARY
Last Name:LALIBERTE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MARY
Other - Last Name:GROVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX B
Mailing Address - Street 2:
Mailing Address - City:WEST ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04865-0702
Mailing Address - Country:US
Mailing Address - Phone:207-230-0110
Mailing Address - Fax:207-230-1116
Practice Address - Street 1:634 ROCKLAND ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856
Practice Address - Country:US
Practice Address - Phone:207-230-0110
Practice Address - Fax:207-230-1116
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN 4240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist