Provider Demographics
NPI:1215221445
Name:LIEBHART, CARL R (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:R
Last Name:LIEBHART
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 1:1108 MARMADUKE CT
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-3717
Mailing Address - Country:US
Mailing Address - Phone:816-809-8276
Mailing Address - Fax:
Practice Address - Street 1:1620 E ROLLINS ST
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-2478
Practice Address - Country:US
Practice Address - Phone:660-263-6642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011015034122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist