MEDICARE: CHRESTENE BIBAWY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	13065	NC
2	1223G0001X	General Practice Dentistry	22DI02689400	NJ
3	1223G0001X	General Practice Dentistry	059361	NY

General Provider Information

NPI Number	:	1992150247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRESTENE BIBAWY D.D.S.

Provider Business Mailing Address
First Line	:	1019 COMMACK DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-6771
Country	:	US
Telephone Number	:	646-258-6357
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 EDWARDS MILL RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-5303
Country	:	US
Telephone Number	:	919-571-0222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2016
Last Update Date	:	11/30/2022

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