Provider Demographics
NPI:1154976348
Name:LIBBY DENTAL
Entity type:Organization
Organization Name:LIBBY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-947-7193
Mailing Address - Street 1:2333 CAMINO DEL RIO S STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3615
Mailing Address - Country:US
Mailing Address - Phone:619-276-6884
Mailing Address - Fax:619-431-5354
Practice Address - Street 1:2333 CAMINO DEL RIO S STE 310
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3615
Practice Address - Country:US
Practice Address - Phone:619-276-6884
Practice Address - Fax:619-431-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty