Healthcare Provider Details

I. General information

NPI: 1528376266
Provider Name (Legal Business Name): DOUGLAS ALLEN TRIBBLE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 12/27/2020
Certification Date: 12/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2481 DEL PRADO BLVD N
CAPE CORAL FL
33909-4002
US

IV. Provider business mailing address

1963 NW 136TH AVE APT 338
SUNRISE FL
33323-5355
US

V. Phone/Fax

Practice location:
  • Phone: 760-338-8011
  • Fax:
Mailing address:
  • Phone: 760-338-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number7187
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number60612
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN24541
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: