Provider Demographics
NPI:1457360232
Name:GOTTLIEB, RICHARD L (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:GOTTLIEB
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 1:3347 FORBES AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-682-7017
Mailing Address - Fax:412-782-4157
Practice Address - Street 1:3347 FORBES AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-682-7017
Practice Address - Fax:412-782-4157
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019619L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist