Provider Demographics
NPI:1619142197
Name:GIEBENHAIN, JOHN NICHOLAS JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NICHOLAS
Last Name:GIEBENHAIN
Suffix:JR
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 1:5851 DULUTH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3946
Mailing Address - Country:US
Mailing Address - Phone:763-454-0330
Mailing Address - Fax:763-277-2096
Practice Address - Street 1:5851 DULUTH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3946
Practice Address - Country:US
Practice Address - Phone:763-454-0330
Practice Address - Fax:763-277-2096
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN88271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice