Provider Demographics
NPI:1023070604
Name:LIEBELT, LYNDON L (DDS)
Entity type:Individual
Prefix:
First Name:LYNDON
Middle Name:L
Last Name:LIEBELT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10555 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE 70
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3857
Mailing Address - Country:US
Mailing Address - Phone:505-296-6100
Mailing Address - Fax:505-271-5490
Practice Address - Street 1:10555 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 70
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3857
Practice Address - Country:US
Practice Address - Phone:505-296-6100
Practice Address - Fax:505-271-5490
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD13011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice