Provider Demographics
NPI:1154598712
Name:MY KIDZ DENTIST, PC
Entity type:Organization
Organization Name:MY KIDZ DENTIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LONA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-253-4488
Mailing Address - Street 1:1741 NEWNAN CROSSING BLVD E
Mailing Address - Street 2:SUITE I
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1599
Mailing Address - Country:US
Mailing Address - Phone:770-253-4488
Mailing Address - Fax:770-253-4498
Practice Address - Street 1:1741 NEWNAN CROSSING BLVD E
Practice Address - Street 2:SUITE I
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1599
Practice Address - Country:US
Practice Address - Phone:770-253-4488
Practice Address - Fax:770-253-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0131601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty