Provider Demographics
NPI:1285894832
Name:LIEBERSBACH, EDWARD PRESTON (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PRESTON
Last Name:LIEBERSBACH
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 1:927 DEEP VALLEY DR STE 220
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3825
Mailing Address - Country:US
Mailing Address - Phone:310-377-5566
Mailing Address - Fax:310-377-5568
Practice Address - Street 1:927 DEEP VALLEY DR
Practice Address - Street 2:STE 220
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3808
Practice Address - Country:US
Practice Address - Phone:310-377-5566
Practice Address - Fax:310-377-5568
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice