NPIMap

Organization Active NPI

Russell J Tibbetts DDS PA

  • Dentist
  • Wilmington, DE
National Provider Identifier
1487662375
Registry record updated Feb 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
894 Issued in DE
Legal business name
RUSSELL J TIBBETTS DDS PA
Practice address
3516 Silverside Road
#17 The Commons
Wilmington, DE 19810-4932
Phone
(302) 479-5959
Fax
(302) 479-5956
NPI assigned
Aug 4, 2006
Last updated
Feb 20, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2012

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

Authorized official

Name
Russell J Tibbetts, DDSNPI 1366715419
Title
President
Phone
(302) 479-5959

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 894 DE Primary

Addresses

Primary practice location

3516 Silverside Road
#17 The Commons
Wilmington, DE 19810-4932

Mailing address

3516 Silverside Road
#17 The Commons
Wilmington, DE 19810-4932
Phone (302) 479-5959

National Provider Directory

National Provider Directory

Locations

3516 Silverside Rd
Ste 17
Wilmington, DE 19810
Phone (302) 479-5959

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329696000000",
    "number": "1487662375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3516 SILVERSIDE ROAD",
            "address_2": "#17 THE COMMONS",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198104932",
            "telephone_number": "302-479-5959",
            "fax_number": "302-479-5956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3516 SILVERSIDE ROAD",
            "address_2": "#17 THE COMMONS",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198104932",
            "telephone_number": "302-479-5959",
            "fax_number": "302-479-5956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL J TIBBETTS DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2012-02-20",
        "status": "A",
        "authorized_official_last_name": "TIBBETTS",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "302-479-5959",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "DE",
            "license": "894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2012; 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.