Provider Demographics
NPI:1073095030
Name:LIBBY, CAITLIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:
Last Name:LIBBY
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 1:103 W GROVE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2062
Mailing Address - Country:US
Mailing Address - Phone:570-587-4787
Mailing Address - Fax:
Practice Address - Street 1:103 W GROVE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-2062
Practice Address - Country:US
Practice Address - Phone:570-587-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4342122300000X
PADS0434771223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist