Provider Demographics
NPI:1659613479
Name:HAEBERLE, EILEEN SCHILLING (DMD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:SCHILLING
Last Name:HAEBERLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3755
Mailing Address - Country:US
Mailing Address - Phone:502-645-0234
Mailing Address - Fax:
Practice Address - Street 1:211 HIGH POINT CT
Practice Address - Street 2:SUITE 500
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-5528
Practice Address - Country:US
Practice Address - Phone:502-538-2400
Practice Address - Fax:502-538-2403
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9319122300000X, 1223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty