Provider Demographics
NPI:1871221663
Name:KIBLER, MADELINE (RDH, RDHAP)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:KIBLER
Suffix:
Gender:F
Credentials:RDH, RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1203
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-1203
Mailing Address - Country:US
Mailing Address - Phone:530-638-3078
Mailing Address - Fax:
Practice Address - Street 1:445 ELM ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3403
Practice Address - Country:US
Practice Address - Phone:530-638-3078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31175124Q00000X
CA912124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist