Provider Demographics
NPI:1134378524
Name:DIBOS, PATRICIA (DMD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:DIBOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 AVENUE C STE 202
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3899
Mailing Address - Country:US
Mailing Address - Phone:201-436-7777
Mailing Address - Fax:
Practice Address - Street 1:654 AVENUE C STE 202
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3899
Practice Address - Country:US
Practice Address - Phone:201-436-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053507122300000X
NY0535011223P0221X
NJ22DI023947001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist