Provider Demographics
NPI:1679750103
Name:WARREN J LIBMAN DDS,MSD,PS
Entity type:Organization
Organization Name:WARREN J LIBMAN DDS,MSD,PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name::LIBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MSD,PS
Authorized Official - Phone:425-453-1308
Mailing Address - Street 1:14595 BEL RED RD
Mailing Address - Street 2:#100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3928
Mailing Address - Country:US
Mailing Address - Phone:425-453-1308
Mailing Address - Fax:425-378-3489
Practice Address - Street 1:14595 BEL RED RD
Practice Address - Street 2:#100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3928
Practice Address - Country:US
Practice Address - Phone:425-453-1308
Practice Address - Fax:425-378-3489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000065241223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty