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Organization
THE BEDSIDE DENTIST LLC
Active
Organization
THE BEDSIDE DENTIST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK LIEBERMAN (MANAGER)
(609) 701-5100
Entity
Organization
Contact information
Practice address
1155 E JERSEY ST, ELIZABETH, NJ 07201-2310
(609) 701-5100
Mailing address
1954 KIMBALL ST, BROOKLYN, NY 11234-4512
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0275140
—
NJ
Enumeration date
11/07/2011
Last updated
11/07/2011
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