Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DE00006524 | WA |
NPI | 1154478097 |
---|---|
Provider Name | Dr. Warren Jay Libman |
First Address | Bellevue, WA 98007-3928 |
Second Address | Bellevue, WA 98007-3928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 08/07/2007 |