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General NPI Number Information
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NPI Number | 1255301503
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Entity Type | Individual
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Provider Name | RICHARD MICHAEL DIBELLA DMD
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Gender | Male
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 620 JOHN PAUL JONES CIR DENTAL DEPARTMENT
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone | 757-953-2710
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Fax | 757-953-0846
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Provider Business Mailing Address
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Address Line | 1416 DERMOTT AVE
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-4120
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Country | US
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Telephone | 757-321-1946
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Fax | 757-953-0846
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 15291
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License Number State | MA
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