Provider Demographics
NPI:1518022532
Name:ICABONE, DENNIS ANTHONY (DDS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:ANTHONY
Last Name:ICABONE
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:PO BOX 269
Mailing Address - Street 2:
Mailing Address - City:FENNVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49408-0269
Mailing Address - Country:US
Mailing Address - Phone:269-561-8661
Mailing Address - Fax:269-561-5833
Practice Address - Street 1:202 E FIRST STREET
Practice Address - Street 2:
Practice Address - City:FENNVILLE
Practice Address - State:MI
Practice Address - Zip Code:49408-0269
Practice Address - Country:US
Practice Address - Phone:269-561-8661
Practice Address - Fax:269-561-5833
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist