Provider Demographics
NPI:1033370887
Name:KEBUS, ANDREW J (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:KEBUS
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:PO BOX 8
Mailing Address - Street 2:1025 CENTER AVENUE
Mailing Address - City:BRODHEAD
Mailing Address - State:WI
Mailing Address - Zip Code:53520-0008
Mailing Address - Country:US
Mailing Address - Phone:608-897-4300
Mailing Address - Fax:
Practice Address - Street 1:1025 CENTER AVENUE
Practice Address - Street 2:ANDREW J KEBUS DDS
Practice Address - City:BRODHEAD
Practice Address - State:WI
Practice Address - Zip Code:53520-0008
Practice Address - Country:US
Practice Address - Phone:608-897-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3882015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist