Provider Demographics
NPI:1811171150
Name:DELIBERO, LAWRENCE (DMD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:DELIBERO
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 1:17 1/2 ELM ST
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5502
Mailing Address - Country:US
Mailing Address - Phone:203-966-1210
Mailing Address - Fax:203-972-3590
Practice Address - Street 1:17 1/2 ELM ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5502
Practice Address - Country:US
Practice Address - Phone:203-966-1210
Practice Address - Fax:203-972-3590
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT69131223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics