Provider Demographics
NPI:1417935784
Name:DIBBLE, KENNETH REID (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:REID
Last Name:DIBBLE
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 1:1509 NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-5231
Mailing Address - Country:US
Mailing Address - Phone:972-840-6100
Mailing Address - Fax:801-572-5751
Practice Address - Street 1:1509 NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5231
Practice Address - Country:US
Practice Address - Phone:972-840-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX383251223G0001X
UT5136779-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice