Provider Demographics
NPI:1255329389
Name:LIEBENTRITT, MICHAEL E (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:LIEBENTRITT
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:PO BOX 328
Mailing Address - Street 2:191 MAIN STREET
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68059-0328
Mailing Address - Country:US
Mailing Address - Phone:402-253-2868
Mailing Address - Fax:402-253-2881
Practice Address - Street 1:191 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NE
Practice Address - Zip Code:68059
Practice Address - Country:US
Practice Address - Phone:402-253-2868
Practice Address - Fax:402-253-2881
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4011122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist