Healthcare Provider Details

I. General information

NPI: 1538179213
Provider Name (Legal Business Name): VICKI L. TIBBS, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 POCAHONTAS TRAIL
QUINTON VA
23141
US

IV. Provider business mailing address

1612 HUGUENOT RD
MIDLOTHIAN VA
23113
US

V. Phone/Fax

Practice location:
  • Phone: 804-932-4537
  • Fax: 804-932-4888
Mailing address:
  • Phone: 804-794-9789
  • Fax: 804-419-1059

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: DR. VICKI LEE TIBBS
Title or Position: DENTIST/PRESIDENT
Credential: DDS
Phone: 804-932-4537