Provider Demographics
NPI:1831236462
Name:LIBIN, LIANA (DDS)
Entity type:Individual
Prefix:DR
First Name:LIANA
Middle Name:
Last Name:LIBIN
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 1:1513 VOORHIES AVE
Mailing Address - Street 2:2 ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3994
Mailing Address - Country:US
Mailing Address - Phone:718-332-5159
Mailing Address - Fax:718-332-0077
Practice Address - Street 1:1513 VOORHIES AVE
Practice Address - Street 2:2 ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3994
Practice Address - Country:US
Practice Address - Phone:718-332-5159
Practice Address - Fax:718-332-0077
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0395251223G0001X
NJ153001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01468551Medicaid