Provider Demographics
NPI:1932292893
Name:DIB, DONALD (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:DIB
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 1:839A RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-5433
Mailing Address - Country:US
Mailing Address - Phone:203-929-1005
Mailing Address - Fax:203-929-1638
Practice Address - Street 1:839A RIVER RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-5433
Practice Address - Country:US
Practice Address - Phone:203-929-1005
Practice Address - Fax:203-929-1638
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0066511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice