Provider Demographics
NPI:1841311560
Name:INCE, DIDEM O (DDS MS PHD)
Entity type:Individual
Prefix:DR
First Name:DIDEM
Middle Name:O
Last Name:INCE
Suffix:
Gender:F
Credentials:DDS MS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 TRIAD WEST DR.
Mailing Address - Street 2:
Mailing Address - City:O'FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366
Mailing Address - Country:US
Mailing Address - Phone:636-281-8800
Mailing Address - Fax:636-281-8801
Practice Address - Street 1:116 TRIAD WEST DR.
Practice Address - Street 2:
Practice Address - City:O'FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366
Practice Address - Country:US
Practice Address - Phone:636-281-8800
Practice Address - Fax:636-281-8801
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0160461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics