Individual
DR. JACK LAWRENCE LIEBERMAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5400 N MILWAUKEE AVE, SUITE1MS, CHICAGO, IL 60630-1272
(773) 774-4121
(773) 774-4123
Mailing address
5400 N MILWAUKEE AVE, SUITE1MS, CHICAGO, IL 60630-1272
(773) 774-4121
(773) 774-4123
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
01912631
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1002718
—
IL
Enumeration date
04/10/2006
Last updated
07/08/2007
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