Provider Demographics
NPI:1174551329
Name:TIBBS, JEFFREY J (DDS, PA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:TIBBS
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 HEALY DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1442
Mailing Address - Country:US
Mailing Address - Phone:336-765-7477
Mailing Address - Fax:336-765-7804
Practice Address - Street 1:3455 HEALY DR
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1442
Practice Address - Country:US
Practice Address - Phone:336-765-7477
Practice Address - Fax:336-765-7804
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC58561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice