Provider Demographics
NPI:1023692886
Name:DR SANTA M. MCKIBBINS, DDS, PA
Entity type:Organization
Organization Name:DR SANTA M. MCKIBBINS, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MCKIBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-672-7587
Mailing Address - Street 1:1413 W NC HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5507
Mailing Address - Country:US
Mailing Address - Phone:919-493-6860
Mailing Address - Fax:
Practice Address - Street 1:1413 W NC HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5507
Practice Address - Country:US
Practice Address - Phone:919-493-6860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty