Brian K Sibbald DDS Inc

Primary specialty

DentistTaxonomy code 122300000X

License

23669 Issued in CA

Legal business name

BRIAN K SIBBALD DDS INC

Practice address

8 W El Rose Dr
Petaluma, CA 94952

Phone

(707) 762-5363

Fax

(707) 762-5116

NPI assigned

Aug 4, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Brian K Sibbald, DDS

Title

Dentist

Phone

(707) 762-5363

Specialties & licenses 1

Addresses

Other names 1

• Medical Corporation Other name

Locations

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192492800000",
    "number": "1669480554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 W EL ROSE DR",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "94952",
            "telephone_number": "707-762-5363",
            "fax_number": "707-762-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 W EL ROSE DR",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "94952",
            "telephone_number": "707-762-5363",
            "fax_number": "707-762-5116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN K SIBBALD DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2007-10-16",
        "status": "A",
        "authorized_official_last_name": "SIBBALD",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "707-762-5363",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "23669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Corporation",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2007; 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.