Individual
DR. JOHN RASCHEN TIBBETTS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
5353 MAIN ST, WILLIAMSVILLE, NY 14221-5337
(716) 634-3511
Mailing address
5353 MAIN ST, WILLIAMSVILLE, NY 14221-5337
(716) 634-3511
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
044104
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01543782
—
NY
Enumeration date
05/24/2005
Last updated
07/08/2007
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