Organization
PAUL D. DIBLEY, D.D.S., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL D. DIBLEY D.D.S. (PRESIDENT)
(715) 526-3315
Entity
Organization
Contact information
Practice address
920 E 5TH ST, SHAWANO, WI 54166-2212
(715) 526-3315
Mailing address
920 E 5TH ST, SHAWANO, WI 54166-2212
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5001351015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33617100
—
WI
Enumeration date
10/24/2005
Last updated
08/22/2020
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