Provider Demographics
NPI:1760933329
Name:SCOTT BIBBENS DMD PL LLC
Entity Type:Organization
Organization Name:SCOTT BIBBENS DMD PL LLC
Other - Org Name:OPEN WIDE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANANGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-663-5722
Mailing Address - Street 1:211 N WHITMAN WAY
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2192
Mailing Address - Country:US
Mailing Address - Phone:509-663-5722
Mailing Address - Fax:509-663-1402
Practice Address - Street 1:211 N WHITMAN WAY
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2192
Practice Address - Country:US
Practice Address - Phone:509-663-5722
Practice Address - Fax:509-663-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000101001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty