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General NPI Number Information
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NPI Number | 1184720856
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Entity Type | Individual
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Provider Name | DAVID LEE DIBBLE DDS
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2550 N MAIN ST
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City | CENTRAL LAKE
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State | MI
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Zip | 49622
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Country | US
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Telephone | 231-544-8115
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Fax |
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Provider Business Mailing Address
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Address Line | 18048 HILLTOP DR
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City | CHARLEVOIX
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State | MI
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Zip | 49720-9783
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Country | US
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Telephone | 231-547-5646
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 290-1013248
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License Number State | MI
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