Organization Name: | DR DAVID E. DIBIASE PLLC |
NPI Number: | 1336173566 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID E DIBIASE (PRESIDENT) |
Mailing Address: | 1401 Main St Follansbee |
State: | WV US |
Postal Code: | 260371217 |
Phone Number: | 3045270250 |
Fax Number: | 3045270888 |
NPI Enumeration Date: | 07/11/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 3459 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |