Provider Demographics
NPI:1912041062
Name:MARYLAND ENDODONTIC GROUP, P.C.
Entity Type:Organization
Organization Name:MARYLAND ENDODONTIC GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-252-3900
Mailing Address - Street 1:22 W PADONIA RD
Mailing Address - Street 2:SUITE C-244
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2226
Mailing Address - Country:US
Mailing Address - Phone:410-252-3900
Mailing Address - Fax:410-252-6051
Practice Address - Street 1:22 W PADONIA RD
Practice Address - Street 2:SUITE C-244
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2226
Practice Address - Country:US
Practice Address - Phone:410-252-3900
Practice Address - Fax:410-252-6051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD61621223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty