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Individual

DR. JAMES JOSEPH DIBELKA JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6001
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6001

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
0401 006200
VA
1223G0001X
General Practice Dentistry
Primary
34691
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0401 006200
DENTAL LICENSE
VA
Enumeration date
08/30/2005
Last updated
03/13/2020
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