Provider Demographics
NPI:1710458526
Name:DIMA SIBAI DDS PC
Entity Type:Organization
Organization Name:DIMA SIBAI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIBAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-484-3929
Mailing Address - Street 1:4 HILLCREST CT
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5710
Mailing Address - Country:US
Mailing Address - Phone:630-484-3929
Mailing Address - Fax:
Practice Address - Street 1:940 PLIANFIELD RD.
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527
Practice Address - Country:US
Practice Address - Phone:630-484-3929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental