Provider Demographics
NPI:1235154691
Name:TIBBS, TODD RICHARD (DDS)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:RICHARD
Last Name:TIBBS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 BADIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NC
Mailing Address - Zip Code:28127-9156
Mailing Address - Country:US
Mailing Address - Phone:336-461-3530
Mailing Address - Fax:
Practice Address - Street 1:1933 JAKE ALEXANDER BLVD W STE 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:704-630-0301
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice