Provider Demographics
NPI:1013138502
Name:LIBBY, DURWIN YANG (DMD)
Entity Type:Individual
Prefix:DR
First Name:DURWIN
Middle Name:YANG
Last Name:LIBBY
Suffix:
Gender:M
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:PO BOX 335
Mailing Address - Street 2:224 ENFIELD ROAD
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-0335
Mailing Address - Country:US
Mailing Address - Phone:207-794-6144
Mailing Address - Fax:207-794-6135
Practice Address - Street 1:224 ENFIELD ROAD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-0335
Practice Address - Country:US
Practice Address - Phone:207-794-6144
Practice Address - Fax:207-794-6135
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME33421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice