Provider Demographics
NPI:1689678088
Name:FASBENDER, MICHAEL J (DDS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:FASBENDER
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 1:128 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-3018
Mailing Address - Country:US
Mailing Address - Phone:507-437-8222
Mailing Address - Fax:
Practice Address - Street 1:128 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-3018
Practice Address - Country:US
Practice Address - Phone:507-437-8222
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN97981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice