Provider Demographics
NPI:1710299193
Name:LIEBERMAN, DAVID MANUEL (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MANUEL
Last Name:LIEBERMAN
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 1:343 KILBURN RD S
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5311
Mailing Address - Country:US
Mailing Address - Phone:516-877-2013
Mailing Address - Fax:
Practice Address - Street 1:656 N WELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-1695
Practice Address - Country:US
Practice Address - Phone:631-225-1010
Practice Address - Fax:631-225-1004
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039653-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice