Provider Demographics
NPI:1427061811
Name:LIEBERMAN, ALAN M (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:M
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 1:3805 BEACON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1464
Mailing Address - Country:US
Mailing Address - Phone:510-796-8333
Mailing Address - Fax:
Practice Address - Street 1:3805 BEACON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1464
Practice Address - Country:US
Practice Address - Phone:510-796-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235321223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-2664805OtherTIN