Provider Demographics
NPI:1871755959
Name:DIVELBISS, JOSHUA WEBB (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:WEBB
Last Name:DIVELBISS
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 1:1805 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1903
Mailing Address - Country:US
Mailing Address - Phone:661-327-3116
Mailing Address - Fax:661-327-2735
Practice Address - Street 1:1805 28TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1903
Practice Address - Country:US
Practice Address - Phone:661-327-3116
Practice Address - Fax:661-327-2735
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice