Provider Demographics
NPI:1275816506
Name:LIBBY, LANDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANDON
Middle Name:
Last Name:LIBBY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 FLETCHER PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3060
Mailing Address - Country:US
Mailing Address - Phone:619-337-7700
Mailing Address - Fax:619-337-7710
Practice Address - Street 1:8555 FLETCHER PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3060
Practice Address - Country:US
Practice Address - Phone:619-337-7700
Practice Address - Fax:619-337-7710
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60867122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist