Provider Demographics
NPI:1144744137
Name:DR ROBERT DIBAUDA INC
Entity Type:Organization
Organization Name:DR ROBERT DIBAUDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBAUDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-349-3844
Mailing Address - Street 1:34501 AURORA RD STE 208
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3831
Mailing Address - Country:US
Mailing Address - Phone:440-349-3844
Mailing Address - Fax:440-349-3869
Practice Address - Street 1:34501 AURORA RD STE 208
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-3831
Practice Address - Country:US
Practice Address - Phone:440-349-3844
Practice Address - Fax:440-349-3869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental