Provider Demographics
NPI:1215038047
Name:DIBONA, DENISE (DDS)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:DIBONA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1701
Mailing Address - Country:US
Mailing Address - Phone:732-530-5111
Mailing Address - Fax:732-741-2584
Practice Address - Street 1:146 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1701
Practice Address - Country:US
Practice Address - Phone:732-530-5111
Practice Address - Fax:732-741-2584
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI158801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice