Healthcare Provider Details

I. General information

NPI: 1336730324
Provider Name (Legal Business Name): KENNETH R DIBBLE DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9853 S 700 E
SANDY UT
84070-3900
US

IV. Provider business mailing address

9853 S 700 E
SANDY UT
84070-3900
US

V. Phone/Fax

Practice location:
  • Phone: 801-572-4430
  • Fax: 801-572-5751
Mailing address:
  • Phone: 801-572-4430
  • Fax: 801-572-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH R DIBBLE
Title or Position: OWNER/PRESIDENT
Credential: DDS
Phone: 801-572-4430