Active NPI
John Raschen Tibbetts, D.D.S., M.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Williamsville, NY
National Provider Identifier
1033112800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 044104
- Practice address
- 5353 Main St
Williamsville, NY 14221-5337 - Phone
- (716) 634-3511
- NPI assigned
- May 24, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 044104 | NY | Primary |
Addresses
Primary practice location
5353 Main St
Williamsville, NY 14221-5337
Mailing address
5353 Main St
Williamsville, NY 14221-5337
Phone (716) 634-3511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01543782 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 044104 | NY | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1033112800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5353 MAIN ST",
"city": "WILLIAMSVILLE",
"state": "NY",
"postal_code": "142215337",
"telephone_number": "716-634-3511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5353 MAIN ST",
"city": "WILLIAMSVILLE",
"state": "NY",
"postal_code": "142215337",
"telephone_number": "716-634-3511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIBBETTS",
"first_name": "JOHN",
"middle_name": "RASCHEN",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-24",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NY",
"license": "044104",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01543782",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Williamsville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.