Provider Demographics
NPI:1154478097
Name:LIBMAN, WARREN JAY (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:JAY
Last Name:LIBMAN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14595 BEL RED RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3928
Mailing Address - Country:US
Mailing Address - Phone:425-453-1308
Mailing Address - Fax:425-378-3489
Practice Address - Street 1:14595 BEL RED RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3928
Practice Address - Country:US
Practice Address - Phone:425-453-1308
Practice Address - Fax:425-378-3489
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000065241223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics