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General NPI Number Information
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NPI Number | 1356697759
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Entity Type | Individual
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Provider Name | BRENT TIBBET DMD, MS
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Gender | Male
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Dates
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Enumeration Date | 08/03/2012
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | NMRTC CORPUS CHRISTI 10651 E STREET
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City | CORPUS CHRISTI
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State | TX
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Zip | 78419-5130
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Country | US
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Telephone | 951-285-3810
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Fax |
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Provider Business Mailing Address
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Address Line | NAVAL MEDICAL READINESS TRAINING CENTER CORPUS CHRISTI 10651 E. STREET, BLDG 100
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City | CORPUS CHRISTI
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State | TX
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Zip | 78419-5130
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 11742021-9924
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License Number State | UT
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