Provider Demographics
NPI:1013051168
Name:LIEBERMAN, JEFFREY ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11007 VALLEY HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3056
Mailing Address - Country:US
Mailing Address - Phone:410-363-6915
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
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD61621223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics