Provider Demographics
NPI:1740220573
Name:DIBONA DENTAL GROUP
Entity Type:Organization
Organization Name:DIBONA DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRES
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIBONA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-772-4352
Mailing Address - Street 1:19 HAMPTON RD
Mailing Address - Street 2:SUITE #11
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4816
Mailing Address - Country:US
Mailing Address - Phone:603-772-4352
Mailing Address - Fax:603-772-5086
Practice Address - Street 1:19 HAMPTON RD
Practice Address - Street 2:SUITE #11
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4816
Practice Address - Country:US
Practice Address - Phone:603-772-4352
Practice Address - Fax:603-772-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty