Provider Demographics
NPI:1184720856
Name:DIBBLE, DAVID LEE (DDS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:DIBBLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18048 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-9783
Mailing Address - Country:US
Mailing Address - Phone:231-547-5646
Mailing Address - Fax:
Practice Address - Street 1:2550 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTRAL LAKE
Practice Address - State:MI
Practice Address - Zip Code:49622
Practice Address - Country:US
Practice Address - Phone:231-544-8115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI290-1013248122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist