Provider Demographics
NPI:1568426252
Name:LIBBESMEIER, JON DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:DAVID
Last Name:LIBBESMEIER
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 1:7023 SWAIN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-1454
Mailing Address - Country:US
Mailing Address - Phone:218-491-5174
Mailing Address - Fax:
Practice Address - Street 1:475 CMR USA DENTAC BAVARIA
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09244-6610
Practice Address - Country:US
Practice Address - Phone:314-350-7714
Practice Address - Fax:314-350-7714
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND115791223G0001X
CO002057921223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice