Provider Demographics
NPI:1912031501
Name:LIEBLICH, DENA G (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENA
Middle Name:G
Last Name:LIEBLICH
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 1:901 RARITAN AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-3601
Mailing Address - Country:US
Mailing Address - Phone:732-339-9004
Mailing Address - Fax:732-339-9005
Practice Address - Street 1:901 RARITAN AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-3601
Practice Address - Country:US
Practice Address - Phone:732-339-9004
Practice Address - Fax:732-339-9005
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0167961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice