Provider Demographics
NPI:1508842220
Name:LIEDER, ROBERT MARC (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARC
Last Name:LIEDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:REPHOEL
Other - Middle Name:MEIR
Other - Last Name:LIEDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:6609 PARK HEIGHTS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215
Mailing Address - Country:US
Mailing Address - Phone:410-764-3400
Mailing Address - Fax:410-764-3401
Practice Address - Street 1:6609 PARK HEIGHTS AVENUE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-764-3400
Practice Address - Fax:410-764-3401
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD134491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice