Healthcare Provider Details

I. General information

NPI: 1578249116
Provider Name (Legal Business Name): SARAH ELIZABETH DIBBLE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 BROADWAY
WEST NEW YORK NJ
07093-2622
US

IV. Provider business mailing address

5301 BROADWAY
WEST NEW YORK NJ
07093-2622
US

V. Phone/Fax

Practice location:
  • Phone: 201-210-0200
  • Fax:
Mailing address:
  • Phone: 201-210-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03165100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: