Provider Demographics
NPI:1306183991
Name:SIBBALD, BRIAN KENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KENT
Last Name:SIBBALD
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 1:255 FAIRVIEW CT
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-1627
Mailing Address - Country:US
Mailing Address - Phone:707-478-0660
Mailing Address - Fax:
Practice Address - Street 1:255 FAIRVIEW CT
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-1627
Practice Address - Country:US
Practice Address - Phone:707-478-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice