Provider Demographics
NPI:1548522709
Name:LIEBERENZ, MEGAN KATHLEEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:KATHLEEN
Last Name:LIEBERENZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 N TELSHOR BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8243
Mailing Address - Country:US
Mailing Address - Phone:505-710-9434
Mailing Address - Fax:
Practice Address - Street 1:530 N TELSHOR BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8243
Practice Address - Country:US
Practice Address - Phone:505-710-9434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD36721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice