Provider Demographics
NPI:1841411659
Name:DAVID E KRIGBAUM DDS SC
Entity Type:Organization
Organization Name:DAVID E KRIGBAUM DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIGBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-842-8811
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:
Mailing Address - Fax:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1750453049OtherNPI NUMBER
WI=========OtherEIN NUMBER