Provider Demographics
NPI:1164541108
Name:DAVID B. NIBOUAR, DMD, PA
Entity Type:Organization
Organization Name:DAVID B. NIBOUAR, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:NIBOUAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-239-0502
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:
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:302-239-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG10008181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty