Provider Demographics
NPI:1619938057
Name:GIEBENHAIN DENTAL ASSOCIATES PA
Entity Type:Organization
Organization Name:GIEBENHAIN DENTAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:GIEBENHAIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-545-0330
Mailing Address - Street 1:5851 DULUTH STREET
Mailing Address - Street 2:SUITE #103
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-545-0330
Mailing Address - Fax:763-277-2096
Practice Address - Street 1:5851 DULUTH STREET
Practice Address - Street 2:SUITE #103
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-545-0330
Practice Address - Fax:763-277-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND8827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty