Provider Demographics
NPI:1073566238
Name:SIBLE, GLEN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:C
Last Name:SIBLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N. DIVISION ST.
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811-0698
Mailing Address - Country:US
Mailing Address - Phone:989-584-3100
Mailing Address - Fax:
Practice Address - Street 1:121 N. DIVISION ST.
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811-0698
Practice Address - Country:US
Practice Address - Phone:989-584-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010094571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4020979Medicaid