Provider Demographics
NPI:1225188469
Name:DIBELLA, JOANN N (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:N
Last Name:DIBELLA
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 1:4757 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3819
Mailing Address - Country:US
Mailing Address - Phone:954-434-3331
Mailing Address - Fax:954-434-4933
Practice Address - Street 1:4757 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3819
Practice Address - Country:US
Practice Address - Phone:954-434-3331
Practice Address - Fax:954-434-4933
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL67651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice