Provider Demographics
NPI:1376568220
Name:DIBBS, ELLIOT D (DDS)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:D
Last Name:DIBBS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 TAMIAMI TRL S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2614
Mailing Address - Country:US
Mailing Address - Phone:941-484-3581
Mailing Address - Fax:941-485-7856
Practice Address - Street 1:400 TAMIAMI TRL S
Practice Address - Street 2:SUITE 110
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2614
Practice Address - Country:US
Practice Address - Phone:941-484-3581
Practice Address - Fax:941-485-7856
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN141771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice