Provider Demographics
NPI:1013185636
Name:LIBAO, MARIA JUVY ROQUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA JUVY
Middle Name:ROQUE
Last Name:LIBAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 BALZAC CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-9330
Mailing Address - Country:US
Mailing Address - Phone:530-222-4917
Mailing Address - Fax:
Practice Address - Street 1:2500 MAIN ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2336
Practice Address - Country:US
Practice Address - Phone:530-529-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-16
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA568271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice