Provider Demographics
NPI:1447346804
Name:DIBELLA, JEROME FRANCIS (DDS)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:FRANCIS
Last Name:DIBELLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2239
Mailing Address - Country:US
Mailing Address - Phone:845-735-5111
Mailing Address - Fax:845-735-0826
Practice Address - Street 1:189 S PEARL ST
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2239
Practice Address - Country:US
Practice Address - Phone:845-735-5111
Practice Address - Fax:845-735-0826
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037803122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist