Provider Demographics
NPI:1245350982
Name:LIBERTO, LILLIAN R (DDS)
Entity type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:R
Last Name:LIBERTO
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 1:9452 HITO CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4914
Mailing Address - Country:US
Mailing Address - Phone:619-602-9438
Mailing Address - Fax:
Practice Address - Street 1:10789 TIERRASANTA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2613
Practice Address - Country:US
Practice Address - Phone:858-565-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA389051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice