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Individual

AMY LEE DIBELLO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
314 S ENNIS ST, PORT ANGELES, WA 98362-4716
(360) 565-6128
Mailing address
314 S ENNIS ST, PORT ANGELES, WA 98362-4716
(360) 565-6128

Taxonomy

Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH60658592
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DH60658592
HYGIENIST
WA
05
DH60658592
WA
Enumeration date
06/19/2018
Last updated
06/19/2018
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