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General NPI Number Information
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NPI Number | 1770506099
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Entity Type | Individual
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Provider Name | LONA DEMETRIA BIBBS DDS
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Gender | Female
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 1741 NEWNAN CROSSING BLVD E SUITE I
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City | NEWNAN
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State | GA
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Zip | 30265-1599
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Country | US
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Telephone | 770-253-4488
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Fax | 770-253-4498
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Provider Business Mailing Address
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Address Line | 151 SOUTHGATE BLVD
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City | MCDONOUGH
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State | GA
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Zip | 30253-8036
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Country | US
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Telephone | 770-871-5158
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN013160
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License Number State | GA
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