Provider Demographics
NPI:1851329379
Name:EBELING, JOHN J II (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:EBELING
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1360 S 5TH ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2449
Mailing Address - Country:US
Mailing Address - Phone:636-946-6747
Mailing Address - Fax:636-946-7629
Practice Address - Street 1:1360 S 5TH ST
Practice Address - Street 2:SUITE 214
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2449
Practice Address - Country:US
Practice Address - Phone:636-946-6747
Practice Address - Fax:636-946-7629
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO139481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice