Provider Demographics
NPI:1659460939
Name:LIEBERMAN, SHILO ISRAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:SHILO
Middle Name:ISRAEL
Last Name:LIEBERMAN
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 1:1309 VIEWMONT DR
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1221
Mailing Address - Country:US
Mailing Address - Phone:518-281-2314
Mailing Address - Fax:518-785-0243
Practice Address - Street 1:1201 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1030
Practice Address - Country:US
Practice Address - Phone:518-785-3084
Practice Address - Fax:518-785-0243
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0368431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice