Provider Demographics
NPI:1760793277
Name:LIBBY, MAUREEN RUTH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:RUTH
Last Name:LIBBY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 NORTH LOOP 1604 EAST
Mailing Address - Street 2:SUITE 2209
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:210-403-0042
Mailing Address - Fax:210-403-0979
Practice Address - Street 1:115 NORTH LOOP 1604 EAST
Practice Address - Street 2:SUITE 2209
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232
Practice Address - Country:US
Practice Address - Phone:210-403-0042
Practice Address - Fax:210-403-0979
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX298421223P0700X
TXTX298421223P0700X
FL18650122300000X
FLDN186501223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist