Provider Demographics
NPI:1992150247
Name:BIBAWY, CHRESTENE (DDS)
Entity type:Individual
Prefix:
First Name:CHRESTENE
Middle Name:
Last Name:BIBAWY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 COMMACK DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6771
Mailing Address - Country:US
Mailing Address - Phone:646-258-6357
Mailing Address - Fax:
Practice Address - Street 1:3101 EDWARDS MILL RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5303
Practice Address - Country:US
Practice Address - Phone:919-571-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-24
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13065122300000X
NJ22DI026894001223G0001X
NY0593611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist