Provider Demographics
NPI:1447600507
Name:PAT AND AMANDA DIBBLE PLLC
Entity Type:Organization
Organization Name:PAT AND AMANDA DIBBLE PLLC
Other - Org Name:DIBBLE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIO
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:DIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:253-838-4770
Mailing Address - Street 1:33801 1ST WAY S STE 201
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6219
Mailing Address - Country:US
Mailing Address - Phone:253-838-4770
Mailing Address - Fax:
Practice Address - Street 1:33801 1ST WAY S STE 201
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6219
Practice Address - Country:US
Practice Address - Phone:253-838-4770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60482588122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty