Provider Demographics
NPI:1689776650
Name:CHIBBARO, JOHN P (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:CHIBBARO
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 1:333 OLD HOOK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3200
Mailing Address - Country:US
Mailing Address - Phone:201-664-2324
Mailing Address - Fax:201-664-2358
Practice Address - Street 1:333 OLD HOOK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3200
Practice Address - Country:US
Practice Address - Phone:201-664-2324
Practice Address - Fax:201-664-2358
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ84161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJOK9957OtherACS HEALTHNET NORTHEAST
NJ1078909Medicaid
NJOK9957OtherACS HEALTHNET NORTHEAST
NJ878462Medicare ID - Type Unspecified