Daniel Patrick Tibbetts, D.M.D

Primary specialty

DentistTaxonomy code 122300000X

License

DS039118 Issued in PA

Practice address

111 S Independence Mall E
Suite 610
Philadelphia, PA 19106-2515

Phone

(215) 238-0800

NPI assigned

Nov 4, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• CCD Ardmore Family Dentistry, LLC

  • General Practice Dentistry
  • Ardmore, PA
  • NPI 1952872228
  NPD (past)
• Society Hill Family Dentistry

  • Dental Clinic/Center
  • Philadelphia, PA
  • NPI 1417734187
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428883200000",
    "number": "1083991053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 WOODCREST AVE",
            "city": "ARDMORE",
            "state": "PA",
            "postal_code": "190031919",
            "telephone_number": "302-545-9444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S INDEPENDENCE MALL E",
            "address_2": "SUITE 610",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191062515",
            "telephone_number": "215-238-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBBETTS",
        "first_name": "DANIEL",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-04",
        "last_updated": "2015-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS039118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• THW Group LLC
• Shashank Raghav Thyarala, MBBS
• Brittany Victoria Tian
• Huikai Tian, M.D., PH.D
• Yiran Tian
• Kathleen Margaret Tibbetts, M.D.
• Phyllis Tiberio
• Alanna Marie Ticali
• Corrie Ann Tice
• Julianne Tice, DPT

• Dentist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.