Provider Demographics
NPI:1528376266
Name:TRIBBLE, DOUGLAS ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALLEN
Last Name:TRIBBLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1963 NW 136TH AVE APT 338
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-5355
Mailing Address - Country:US
Mailing Address - Phone:760-338-8011
Mailing Address - Fax:
Practice Address - Street 1:2481 DEL PRADO BLVD N
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-4002
Practice Address - Country:US
Practice Address - Phone:760-338-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV71871223P0700X
CA606121223P0700X
FLDN245411223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics