Provider Demographics
NPI:1316254006
Name:KIBBEY, MEGAN MARIE (DMD, PHD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:KIBBEY
Suffix:
Gender:F
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:KIBBEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD, PHD
Mailing Address - Street 1:1859 SAVAGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4726
Mailing Address - Country:US
Mailing Address - Phone:843-722-5733
Mailing Address - Fax:
Practice Address - Street 1:1859 SAVAGE RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4726
Practice Address - Country:US
Practice Address - Phone:843-722-5733
Practice Address - Fax:508-823-7932
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1855524122300000X
SC4535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist