Provider Demographics
NPI:1225176571
Name:LIBKE, JOHN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:LIBKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:MICHAEL
Other - Last Name:LIBKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:D,D,S,
Mailing Address - Street 1:1720 HUNTER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-0679
Mailing Address - Country:US
Mailing Address - Phone:775-787-7179
Mailing Address - Fax:
Practice Address - Street 1:1720 HUNTER CREEK RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-0679
Practice Address - Country:US
Practice Address - Phone:775-787-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2009-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice