Provider Demographics
NPI:1770506099
Name:BIBBS, LONA DEMETRIA (DDS)
Entity type:Individual
Prefix:DR
First Name:LONA
Middle Name:DEMETRIA
Last Name:BIBBS
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 1:151 SOUTHGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8036
Mailing Address - Country:US
Mailing Address - Phone:770-871-5158
Mailing Address - Fax:
Practice Address - Street 1:1741 NEWNAN CROSSING BLVD E
Practice Address - Street 2:SUITE I
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1599
Practice Address - Country:US
Practice Address - Phone:770-253-4488
Practice Address - Fax:770-253-4498
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0131601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA730602079AMedicaid
GA730602079EMedicaid
GA730602079BMedicaid