| NPI | 1093068744 |
|---|---|
| Other Name | KACI L. TIBBETTS |
| Entity Type | Organization |
| Authorized Contact | KACI TIBBETTS Owner 210-496-5422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 26455) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 12844) |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2018-06-22 |