Provider Demographics
NPI:1437418928
Name:LIBATIQUE, GESILE (RDH)
Entity Type:Individual
Prefix:
First Name:GESILE
Middle Name:
Last Name:LIBATIQUE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:GESILE
Other - Middle Name:
Other - Last Name:LIBATIQUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDHAP
Mailing Address - Street 1:145 ARREBA ST
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-2409
Mailing Address - Country:US
Mailing Address - Phone:925-323-7442
Mailing Address - Fax:
Practice Address - Street 1:145 ARREBA ST
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-2409
Practice Address - Country:US
Practice Address - Phone:925-323-7442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17461124Q00000X
MNH6294124Q00000X
NMDH2354124Q00000X
CARDHAP662124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist