Healthcare Provider Details

I. General information

NPI: 1427158005
Provider Name (Legal Business Name): STUART DALE SIBLEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12350 LAKE JUNE RD STE 102
BALCH SPRINGS TX
75180-1600
US

IV. Provider business mailing address

12350 LAKE JUNE RD STE 102
BALCH SPRINGS TX
75180-1600
US

V. Phone/Fax

Practice location:
  • Phone: 972-557-4047
  • Fax:
Mailing address:
  • Phone: 972-557-4047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11857
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: