Provider Demographics
NPI:1508958273
Name:DAVID DIBBLE DDS PC
Entity Type:Organization
Organization Name:DAVID DIBBLE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-544-8115
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:2550 N MAIN STREET
Mailing Address - City:CENTRAL LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49622
Mailing Address - Country:US
Mailing Address - Phone:231-544-8115
Mailing Address - Fax:231-544-6012
Practice Address - Street 1:2550 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:CENTRAL LAKE
Practice Address - State:MI
Practice Address - Zip Code:49622
Practice Address - Country:US
Practice Address - Phone:231-544-8115
Practice Address - Fax:231-544-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013248122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty