Provider Demographics
NPI:1346292190
Name:HABECKER, DAVID EARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EARL
Last Name:HABECKER
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 1:529 N GRAND ST
Mailing Address - Street 2:P. O. BOX 716
Mailing Address - City:SCHOOLCRAFT
Mailing Address - State:MI
Mailing Address - Zip Code:49087-0716
Mailing Address - Country:US
Mailing Address - Phone:269-679-5584
Mailing Address - Fax:269-679-5028
Practice Address - Street 1:529 N GRAND ST
Practice Address - Street 2:
Practice Address - City:SCHOOLCRAFT
Practice Address - State:MI
Practice Address - Zip Code:49087-9128
Practice Address - Country:US
Practice Address - Phone:269-679-5584
Practice Address - Fax:269-679-5028
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0153251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID153250OtherBCBS ID