Individual
DR. DORRETTE JON IBAZEBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
6425 OLD PLANK RD, SUITE 102, HIGH POINT, NC 27265-3277
(336) 886-1747
Mailing address
7109 HORSEMAN CT, SUMMERFIELD, NC 27358-9293
(336) 788-6070
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8686
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5910831
—
NC
Enumeration date
09/11/2008
Last updated
12/15/2011
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