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General NPI Number Information
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NPI Number | 1366691651
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Entity Type | Individual
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Provider Name | DORRETTE JON IBAZEBO D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 6425 OLD PLANK RD SUITE 102
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City | HIGH POINT
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State | NC
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Zip | 27265-3277
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Country | US
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Telephone | 336-886-1747
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Fax |
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Provider Business Mailing Address
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Address Line | 7109 HORSEMAN CT
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City | SUMMERFIELD
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State | NC
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Zip | 27358-9293
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Country | US
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Telephone | 336-788-6070
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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 | 8686
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License Number State | NC
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