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General NPI Number Information
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NPI Number | 1891434445
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Entity Type | Organization
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Legal Business Name | KENNETH R DIBBLE DDS
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 1509 NORTHWEST HWY
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City | GARLAND
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State | TX
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Zip | 75041-5231
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Country | US
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Telephone | 972-840-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 908 E RIPARIAN DR
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City | DRAPER
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State | UT
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Zip | 84020-8541
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Country | US
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Telephone | 801-232-7022
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | KENNETH REID DIBBLE
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Credential | DDS
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Telephone | 801-232-7022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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