Provider Demographics
NPI:1164550208
Name:EBBEN & PYNENBERG DDS SC
Entity Type:Organization
Organization Name:EBBEN & PYNENBERG DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:EBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-788-3542
Mailing Address - Street 1:607 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140
Mailing Address - Country:US
Mailing Address - Phone:920-788-3542
Mailing Address - Fax:920-788-6741
Practice Address - Street 1:607 WILSON ST
Practice Address - Street 2:
Practice Address - City:LITTLE CHUTE
Practice Address - State:WI
Practice Address - Zip Code:54140
Practice Address - Country:US
Practice Address - Phone:920-788-3542
Practice Address - Fax:920-788-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2739122300000X
WI4142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty