Provider Demographics
NPI:1427158005
Name:SIBLEY, STUART DALE (DDS)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:DALE
Last Name:SIBLEY
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 1:12350 LAKE JUNE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BALCH SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75180-1600
Mailing Address - Country:US
Mailing Address - Phone:972-557-4047
Mailing Address - Fax:
Practice Address - Street 1:12350 LAKE JUNE RD STE 102
Practice Address - Street 2:
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-1600
Practice Address - Country:US
Practice Address - Phone:972-557-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice