Provider Demographics
NPI:1518129253
Name:DR. LAWRENCE B. DIBONA
Entity Type:Organization
Organization Name:DR. LAWRENCE B. DIBONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DIBONA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-235-4862
Mailing Address - Street 1:169 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY HLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-3121
Mailing Address - Country:US
Mailing Address - Phone:781-235-4862
Mailing Address - Fax:781-235-4868
Practice Address - Street 1:169 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY HLS
Practice Address - State:MA
Practice Address - Zip Code:02481-3121
Practice Address - Country:US
Practice Address - Phone:781-235-4862
Practice Address - Fax:781-235-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty