Provider Demographics
NPI:1588824841
Name:BIBKO, JOHN S (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:BIBKO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 MAIN AVE
Mailing Address - Street 2:SUITE #D
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1592
Mailing Address - Country:US
Mailing Address - Phone:203-866-7806
Mailing Address - Fax:
Practice Address - Street 1:346 MAIN AVE
Practice Address - Street 2:SUITE #D
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1592
Practice Address - Country:US
Practice Address - Phone:203-866-7806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0104821223X0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program