Provider Demographics
NPI:1568991636
Name:BIBKO ORTHODONTICS LLC
Entity Type:Organization
Organization Name:BIBKO ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BIBKO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-866-7806
Mailing Address - Street 1:346 MAIN AVE STE D
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1591
Mailing Address - Country:US
Mailing Address - Phone:203-866-7806
Mailing Address - Fax:
Practice Address - Street 1:346 MAIN AVE STE D
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1591
Practice Address - Country:US
Practice Address - Phone:203-866-7806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty