Individual
MRS. KYLEA MARIE TIBBS-HNIZDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D
Contact information
Practice address
2239 E COOK ST, SPRINGFIELD, IL 62703-1944
(217) 788-2300
(217) 788-2342
Mailing address
415 S 9TH ST, PETERSBURG, IL 62675-1621
(217) 415-2426
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019028844
IL
Other
Enumeration date
09/30/2011
Last updated
03/28/2017
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