Provider Demographics
NPI:1972508919
Name:LIEB, HOWARD IRA ALLAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:IRA ALLAN
Last Name:LIEB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6723
Mailing Address - Country:US
Mailing Address - Phone:718-761-3200
Mailing Address - Fax:718-698-6378
Practice Address - Street 1:3200 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6723
Practice Address - Country:US
Practice Address - Phone:718-761-3200
Practice Address - Fax:718-698-6378
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice