Provider Demographics
NPI:1861794430
Name:TIBBETTS, KACI L (DDS)
Entity type:Individual
Prefix:
First Name:KACI
Middle Name:L
Last Name:TIBBETTS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DRIVE UT HEALTH SCIENCE CENTER AT SAN A
Mailing Address - Street 2:MSC 7914, DEPT OF COMPREHENSIVE DENTISTRY
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3900
Mailing Address - Country:US
Mailing Address - Phone:210-567-3456
Mailing Address - Fax:210-567-3443
Practice Address - Street 1:3223 THOUSAND OAKS DR STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3573
Practice Address - Country:US
Practice Address - Phone:210-496-5422
Practice Address - Fax:210-490-2388
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX264551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice