Provider Demographics
NPI:1609286426
Name:GOTTLIEB, BRIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:GOTTLIEB
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 1:5784 LINDERO CANYON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4088
Mailing Address - Country:US
Mailing Address - Phone:818-706-0131
Mailing Address - Fax:818-706-0151
Practice Address - Street 1:5784 LINDERO CANYON RD
Practice Address - Street 2:SUITE B
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4088
Practice Address - Country:US
Practice Address - Phone:818-706-0131
Practice Address - Fax:818-706-0151
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA631661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice