Provider Demographics
NPI:1528553732
Name:TIBBITTS, ABBY MCCLELLAN (DMD)
Entity type:Individual
Prefix:DR
First Name:ABBY
Middle Name:MCCLELLAN
Last Name:TIBBITTS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ABBY
Other - Middle Name:MCCLELLAN
Other - Last Name:KERBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3307 NORTHLAND DRIVE
Mailing Address - Street 2:STE 230
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-388-2220
Mailing Address - Fax:
Practice Address - Street 1:3307 NORTHLAND DRIVE
Practice Address - Street 2:STE 230
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-388-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN107821223G0001X
KY105741223G0001X
TX408371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice