Provider Demographics
NPI:1336173566
Name:DR DAVID E. DIBIASE PLLC
Entity Type:Organization
Organization Name:DR DAVID E. DIBIASE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIBIASE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-527-0250
Mailing Address - Street 1:1401 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOLLANSBEE
Mailing Address - State:WV
Mailing Address - Zip Code:26037-1217
Mailing Address - Country:US
Mailing Address - Phone:304-527-0250
Mailing Address - Fax:304-527-0888
Practice Address - Street 1:1401 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOLLANSBEE
Practice Address - State:WV
Practice Address - Zip Code:26037-1217
Practice Address - Country:US
Practice Address - Phone:304-527-0250
Practice Address - Fax:304-527-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3459261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental