Provider Demographics
NPI:1740377514
Name:LIEBERMAN, LAWRENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
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 1:10 WILLOWWOOD LN
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2058
Mailing Address - Country:US
Mailing Address - Phone:727-785-8017
Mailing Address - Fax:
Practice Address - Street 1:35691 US 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1739
Practice Address - Country:US
Practice Address - Phone:727-785-8017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL96611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice