Provider Demographics
NPI:1003827544
Name:TODD R. TIBBS, D.D.S., P.A.
Entity Type:Organization
Organization Name:TODD R. TIBBS, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:TIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-633-1799
Mailing Address - Street 1:1933 JAKE ALEXANDER BLVD. WEST, SUITE 203
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147
Mailing Address - Country:US
Mailing Address - Phone:704-633-1799
Mailing Address - Fax:
Practice Address - Street 1:1933 JAKE ALEXANDER BLVD. WEST, SUITE 203
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1156
Practice Address - Country:US
Practice Address - Phone:704-633-1799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV06475OtherTX-BCBS
NC0166WOtherBCBS
PA976699OtherUNITED CONCORDIA
NC9001KOtherBCBS
VA433519OtherTRIGON-BCBS
VA433519OtherTRIGON-BCBS