Provider Demographics
NPI:1700030541
Name:ALAN M. LIEBERMAN, D.D.S., APC
Entity Type:Organization
Organization Name:ALAN M. LIEBERMAN, D.D.S., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEEVON
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-796-8333
Mailing Address - Street 1:3805 BEACON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1464
Mailing Address - Country:US
Mailing Address - Phone:510-796-8333
Mailing Address - Fax:
Practice Address - Street 1:3805 BEACON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1464
Practice Address - Country:US
Practice Address - Phone:510-796-8333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235321223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty