Provider Demographics
NPI:1841444247
Name:DIBOR, CHINYELU (DMD)
Entity type:Individual
Prefix:
First Name:CHINYELU
Middle Name:
Last Name:DIBOR
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 1:5525 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3316
Mailing Address - Country:US
Mailing Address - Phone:215-843-4900
Mailing Address - Fax:215-843-3130
Practice Address - Street 1:5525 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3316
Practice Address - Country:US
Practice Address - Phone:215-843-4900
Practice Address - Fax:215-843-3130
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029890L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice