Paul D. Dibley, D.D.S., S.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5001351015 Issued in WI

Legal business name

PAUL D. DIBLEY, D.D.S., S.C.

Practice address

920 E 5TH St
Shawano, WI 54166-2212

Phone

(715) 526-3315

NPI assigned

Oct 24, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Paul D. Dibley, D.D.S.

Title

President

Phone

(715) 526-3315

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720078512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 E 5TH ST",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541662212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 E 5TH ST",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541662212",
            "telephone_number": "715-526-3315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL D. DIBLEY, D.D.S., S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DIBLEY",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-526-3315",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5001351015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33617100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew James Osborne, PT
• Kirby Elizabeth Otto, APNP
• Pai Participant 23 SC
• Ann M Papendorf, APNP
• Angela M Parmentier, DNP, APNP, NP-C, RN-
• Emma Pavletich
• Tyler Pensis
• Brittany L Perkins, P.T.
• Thomas G Peterson, O.D.
• Kristie R. Petry, REGISTERED NURSE

• General Practice Dentistry in Shawano, WI
• Providers in Shawano, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.