Provider Demographics
NPI:1104986546
Name:HIBBARD, JEFFREY GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GEORGE
Last Name:HIBBARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 SHAW AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-3847
Mailing Address - Country:US
Mailing Address - Phone:559-298-0222
Mailing Address - Fax:
Practice Address - Street 1:334 SHAW AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3847
Practice Address - Country:US
Practice Address - Phone:559-298-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44693122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist