MEDICARE: DAVID DIBBLE DDS PC

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
1	122300000X	Dentist	2901013248	MI

General Provider Information

NPI Number	:	1508958273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID DIBBLE DDS PC

Provider Business Mailing Address
First Line	:	PO BOX 457
Second Line	:	2550 N MAIN STREET
City	:	CENTRAL LAKE
State	:	MI
Zip	:	49622
Country	:	US
Telephone Number	:	231-544-8115
Fax Number	:	231-544-6012

Provider Business Practice Location Address
First Line	:	2550 N MAIN STREET
Second Line	:
City	:	CENTRAL LAKE
State	:	MI
Zip	:	49622
Country	:	US
Telephone Number	:	231-544-8115
Fax Number	:	231-544-6012

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID LEE DIBBLE
Credential	:	DDS
Telephone Number	:	231-544-8115

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	08/22/2020

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