Provider Demographics
NPI:1972553246
Name:LIBBY, WARREN DAVID (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:DAVID
Last Name:LIBBY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 OMALLEY RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3032
Mailing Address - Country:US
Mailing Address - Phone:907-349-1951
Mailing Address - Fax:907-349-5107
Practice Address - Street 1:1000 OMALLEY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3032
Practice Address - Country:US
Practice Address - Phone:907-349-1951
Practice Address - Fax:907-349-5107
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11801223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD4125Medicaid
AK1760650OtherUNITED CONCORDIA PROVIDER