Healthcare Provider Details

I. General information

NPI: 1154498558
Provider Name (Legal Business Name): ANDREW TIBBITS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40710 CALIFORNIA OAKS RD STE A
MURRIETA CA
92562-5727
US

IV. Provider business mailing address

40710 CALIFORNIA OAKS RD STE A
MURRIETA CA
92562-5727
US

V. Phone/Fax

Practice location:
  • Phone: 951-677-5113
  • Fax: 951-696-5180
Mailing address:
  • Phone: 951-677-5113
  • Fax: 951-696-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: