Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 9884 | ND |
N | 208600000X | Surgeon | 9884 | ND |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 9884 | ND |
NPI | 1093738064 |
---|---|
Provider Name | David G Dibbell JR. |
First Address | Bismarck, ND 58506-5501 |
Second Address | Bismarck, ND 58501-4436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 10/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13325 | (05) | ND |
B52425 | (02) | ND |