Provider Demographics
NPI:1902825219
Name:KIBELBEK, ANTHONY M (DMD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:KIBELBEK
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 1:850 MAIN STREET
Mailing Address - Street 2:P.O. BOX 375
Mailing Address - City:COALPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16627
Mailing Address - Country:US
Mailing Address - Phone:814-941-2955
Mailing Address - Fax:
Practice Address - Street 1:850 MAIN STREET
Practice Address - Street 2:
Practice Address - City:COALPORT
Practice Address - State:PA
Practice Address - Zip Code:16627
Practice Address - Country:US
Practice Address - Phone:814-672-5480
Practice Address - Fax:814-672-5461
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025-866L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist