Provider Demographics
NPI:1497265045
Name:LIEBERMAN, IAN ROSS (DMD, MS)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:ROSS
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11153 MERIDIAN DR N
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4617
Mailing Address - Country:US
Mailing Address - Phone:561-722-3276
Mailing Address - Fax:
Practice Address - Street 1:11153 MERIDIAN DR N
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-4617
Practice Address - Country:US
Practice Address - Phone:561-722-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN215211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics