Provider Demographics
NPI:1427056316
Name:LIEBERMAN, MATTHEW S (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
Last Name:LIEBERMAN
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 1:33 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3901
Mailing Address - Country:US
Mailing Address - Phone:718-636-8552
Mailing Address - Fax:718-677-1798
Practice Address - Street 1:33 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3901
Practice Address - Country:US
Practice Address - Phone:718-636-8552
Practice Address - Fax:718-677-1798
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
NY049210122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist