Provider Demographics
NPI:1609941350
Name:TIBAJIA, NOEL BASCON (DDS)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:BASCON
Last Name:TIBAJIA
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 1:10827 S 51ST ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1742
Mailing Address - Country:US
Mailing Address - Phone:480-785-9600
Mailing Address - Fax:480-785-9608
Practice Address - Street 1:10827 S 51ST ST
Practice Address - Street 2:SUITE 204
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1742
Practice Address - Country:US
Practice Address - Phone:480-785-9600
Practice Address - Fax:480-785-9608
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4604122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist