Provider Demographics
NPI:1730668872
Name:PRIEBE, MARGARET ANN (DDS)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:PRIEBE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N WASHINGTON ST APT 301
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-5147
Mailing Address - Country:US
Mailing Address - Phone:715-370-2642
Mailing Address - Fax:
Practice Address - Street 1:2352 LINEVILLE RD STE 112
Practice Address - Street 2:
Practice Address - City:SUAMICO
Practice Address - State:WI
Practice Address - Zip Code:54313-8863
Practice Address - Country:US
Practice Address - Phone:920-471-4988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001795-151223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program