Provider Demographics
NPI:1720180714
Name:LIEBERMAN, MICHELLE AMY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:AMY
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MADISON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2734
Mailing Address - Country:US
Mailing Address - Phone:201-556-0006
Mailing Address - Fax:201-556-0063
Practice Address - Street 1:22 MADISON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2734
Practice Address - Country:US
Practice Address - Phone:201-556-0006
Practice Address - Fax:201-556-0063
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI022834001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry