Provider Demographics
NPI:1235569435
Name:DIBARTOLA, WAYNE JOSEPH JR (DMD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:JOSEPH
Last Name:DIBARTOLA
Suffix:JR
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 1:3240 WASHINGTON PIKE
Mailing Address - Street 2:SUITE 1107
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1413
Mailing Address - Country:US
Mailing Address - Phone:412-221-9440
Mailing Address - Fax:412-221-1377
Practice Address - Street 1:3249 WASHINGTON PIKE
Practice Address - Street 2:SUITE 1107
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1461
Practice Address - Country:US
Practice Address - Phone:412-221-9440
Practice Address - Fax:412-221-1377
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024638L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist