Provider Demographics
NPI:1760650972
Name:GARY N. KREBILL,DDS,PC
Entity Type:Organization
Organization Name:GARY N. KREBILL,DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:KREBILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-323-9554
Mailing Address - Street 1:4341 S WESTNEDGE AVE
Mailing Address - Street 2:SUITE 2112
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3289
Mailing Address - Country:US
Mailing Address - Phone:269-382-5040
Mailing Address - Fax:
Practice Address - Street 1:4341 S WESTNEDGE AVE
Practice Address - Street 2:SUITE 2112
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3289
Practice Address - Country:US
Practice Address - Phone:269-382-5040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI113221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty