Provider Demographics
NPI:1730378167
Name:DUBEL, VICTOR JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:JOHN
Last Name:DUBEL
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 1:453 PATTERSON ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419
Mailing Address - Country:US
Mailing Address - Phone:937-298-5110
Mailing Address - Fax:937-298-5887
Practice Address - Street 1:453 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-4343
Practice Address - Country:US
Practice Address - Phone:937-429-8511
Practice Address - Fax:937-298-5887
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-18499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0761635Medicaid