Provider Demographics
NPI:1750453049
Name:KRIGBAUM, DAVID EDMUND (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDMUND
Last Name:KRIGBAUM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2620 STEWART AVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4170
Mailing Address - Country:US
Mailing Address - Phone:715-842-8811
Mailing Address - Fax:715-848-5109
Practice Address - Street 1:2620 STEWART AVE
Practice Address - Street 2:SUITE 218
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4170
Practice Address - Country:US
Practice Address - Phone:715-842-8811
Practice Address - Fax:715-848-5109
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI45011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery