Provider Demographics
NPI:1538632591
Name:WIBLE, EMILY (DMD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:WIBLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 BRIARGATE DR # 101
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2225
Mailing Address - Country:US
Mailing Address - Phone:267-293-9225
Mailing Address - Fax:
Practice Address - Street 1:484 BRIARGATE DR UNIT 101
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-2225
Practice Address - Country:US
Practice Address - Phone:847-289-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190305891223G0001X
IL0210028881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice