Provider Demographics
NPI:1164563664
Name:DIB, ZIAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ZIAD
Middle Name:
Last Name:DIB
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 1:627 S PRESTON ST
Mailing Address - Street 2:APT 5C
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1743
Mailing Address - Country:US
Mailing Address - Phone:502-314-4443
Mailing Address - Fax:502-852-1317
Practice Address - Street 1:501 S PRESTON
Practice Address - Street 2:ROOM 236
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40292-0001
Practice Address - Country:US
Practice Address - Phone:502-852-6928
Practice Address - Fax:502-852-1317
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY81491223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics