Provider Demographics
NPI:1861645202
Name:DABELL, MICHAEL VERLYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VERLYN
Last Name:DABELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1550 N CRESTMONT DR STE G
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2177
Mailing Address - Country:US
Mailing Address - Phone:208-884-0100
Mailing Address - Fax:208-884-4844
Practice Address - Street 1:1550 N CRESTMONT DR STE G
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2177
Practice Address - Country:US
Practice Address - Phone:208-884-0100
Practice Address - Fax:208-884-4844
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADR 600353961223S0112X
IDD-4099-OS1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery