Provider Demographics
NPI:1003916537
Name:NIBOUAR, DAVID BENEDICT (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BENEDICT
Last Name:NIBOUAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 LIMESTONE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1252
Mailing Address - Country:US
Mailing Address - Phone:302-239-0502
Mailing Address - Fax:302-232-9071
Practice Address - Street 1:5317 LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1252
Practice Address - Country:US
Practice Address - Phone:302-239-0502
Practice Address - Fax:302-232-9071
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG10008181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice