Healthcare Provider Details

I. General information

NPI: 1144154238
Provider Name (Legal Business Name): LIBBY BREZNYAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 SILVER ST
WATERVILLE ME
04901-5935
US

IV. Provider business mailing address

1039 AUGUSTA RD
BELGRADE ME
04917-3727
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-2073
  • Fax:
Mailing address:
  • Phone: 207-873-2073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN5344
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: