Provider Demographics
NPI:1639837206
Name:DIBBLE, EDMOND SPENCER III
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:SPENCER
Last Name:DIBBLE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611
Mailing Address - Country:US
Mailing Address - Phone:585-627-1777
Mailing Address - Fax:
Practice Address - Street 1:1533 MEADOWBROOK LANE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425
Practice Address - Country:US
Practice Address - Phone:813-892-9373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist