Provider Demographics
NPI:1295962421
Name:ABBOTT-MCKIBBEN, HELEN HAYES (RDH)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:HAYES
Last Name:ABBOTT-MCKIBBEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9206 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-4838
Mailing Address - Country:US
Mailing Address - Phone:806-771-7171
Mailing Address - Fax:
Practice Address - Street 1:4013 84TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1913
Practice Address - Country:US
Practice Address - Phone:806-794-8365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8604124Q00000X
NM638124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist