Provider Demographics
NPI:1245526870
Name:BIBBINS, KIMBERLY SMITH (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:SMITH
Last Name:BIBBINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 WEBER ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-4124
Mailing Address - Country:US
Mailing Address - Phone:337-828-2550
Mailing Address - Fax:337-828-2550
Practice Address - Street 1:1115 WEBER ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-4124
Practice Address - Country:US
Practice Address - Phone:337-828-2550
Practice Address - Fax:337-828-2550
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN94581223G0001X
TX287571223D0001X, 1223G0001X
LAS-711390200000X
LA64131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126826002Medicaid
TX451821OtherMEDICARE PART A - GROUP
LA5B803OtherMEDICARE PART B - GROUP
TX00HE78OtherMEDICARE PART B - GROUP
LA2890573Medicaid
LA600664Medicare Oscar/Certification