Provider Demographics
NPI:1508861626
Name:LIBBY, LEWIS SIMPSON III (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:SIMPSON
Last Name:LIBBY
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7600 OSLER DR
Mailing Address - Street 2:STE 100
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7705
Mailing Address - Country:US
Mailing Address - Phone:410-321-1144
Mailing Address - Fax:410-321-1162
Practice Address - Street 1:7600 OSLER DR
Practice Address - Street 2:STE 100
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7705
Practice Address - Country:US
Practice Address - Phone:410-321-1144
Practice Address - Fax:410-321-1162
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD061611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice