Healthcare Provider Details

I. General information

NPI: 1245526870
Provider Name (Legal Business Name): KIMBERLY SMITH BIBBINS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 WEBER ST
FRANKLIN LA
70538-4124
US

IV. Provider business mailing address

1115 WEBER ST
FRANKLIN LA
70538-4124
US

V. Phone/Fax

Practice location:
  • Phone: 337-828-2550
  • Fax: 337-828-2550
Mailing address:
  • Phone: 337-828-2550
  • Fax: 337-828-2550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9458
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number28757
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS-711
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6413
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number28757
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: