Provider Demographics
NPI:1417582958
Name:BIBBER, ERIN M (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:M
Last Name:BIBBER
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2263
Mailing Address - Country:US
Mailing Address - Phone:203-405-6301
Mailing Address - Fax:
Practice Address - Street 1:250 MAIN ST S
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2263
Practice Address - Country:US
Practice Address - Phone:614-722-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT133411223P0221X
OH30.0264141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0413377Medicaid