Healthcare Provider Details

I. General information

NPI: 1679750103
Provider Name (Legal Business Name): WARREN J LIBMAN DDS,MSD,PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14595 BEL RED RD #100
BELLEVUE WA
98007-3928
US

IV. Provider business mailing address

14595 BEL RED RD #100
BELLEVUE WA
98007-3928
US

V. Phone/Fax

Practice location:
  • Phone: 425-453-1308
  • Fax: 425-378-3489
Mailing address:
  • Phone: 425-453-1308
  • Fax: 425-378-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDE00006524
License Number StateWA

VIII. Authorized Official

Name: DR. WARREN JAY :LIBMAN
Title or Position: DENTIST
Credential: DDS,MSD,PS
Phone: 425-453-1308