Healthcare Provider Details

I. General information

NPI: 1730042706
Provider Name (Legal Business Name): BRITTANY TIBBETTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9610 N METRO PKWY W
PHOENIX AZ
85051-1402
US

IV. Provider business mailing address

655 W PORT AU PRINCE LN
PHOENIX AZ
85023-5293
US

V. Phone/Fax

Practice location:
  • Phone: 480-964-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH008995
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: