Healthcare Provider Details

I. General information

NPI: 1255518726
Provider Name (Legal Business Name): VICKI LEE TIBBS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 POCAHONTAS TRAIL
QUINTON VA
23141
US

IV. Provider business mailing address

P O BOX 186
QUINTON VA
23141
US

V. Phone/Fax

Practice location:
  • Phone: 804-932-4537
  • Fax: 804-932-4888
Mailing address:
  • Phone: 804-932-4537
  • Fax: 804-932-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6227
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: