Provider Demographics
NPI:1982174744
Name:TIBAVINSKY, MARIA GABRIELA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:GABRIELA
Last Name:TIBAVINSKY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:GABRIELA
Other - Last Name:TIBAVINSKY BERNAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-3204
Mailing Address - Country:US
Mailing Address - Phone:678-548-0959
Mailing Address - Fax:
Practice Address - Street 1:1667 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4962
Practice Address - Country:US
Practice Address - Phone:212-289-4131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0156571223G0001X
NY060774122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice