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NPI Code Detail

MEDICARE: DR. JAMES JOSEPH DIBELKA JR. DDS

MEDICARE: DR. JAMES JOSEPH DIBELKA JR. DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry0401 006200VA
21223G0001XGeneral Practice Dentistry34691CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10401 006200OTHERVADENTAL LICENSE

General Provider Information

NPI Number : 1336132984
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES JOSEPH DIBELKA JR. DDS
Provider Business Mailing Address
First Line : PO BOX 160
Second Line :
City : SHIPROCK
State : NM
Zip : 87420-0160
Country : US
Telephone Number : 505-368-6001
Fax Number :
Provider Business Practice Location Address
First Line : US HWY 491 NORTH
Second Line :
City : SHIPROCK
State : NM
Zip : 87420
Country : US
Telephone Number : 505-368-6001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 03/13/2020

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