Provider Demographics
NPI:1891819934
Name:KREBSBACH, PAUL H (DDS PHD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:H
Last Name:KREBSBACH
Suffix:
Gender:M
Credentials:DDS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1078
Mailing Address - Country:US
Mailing Address - Phone:734-763-5280
Mailing Address - Fax:734-763-3453
Practice Address - Street 1:1011 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1078
Practice Address - Country:US
Practice Address - Phone:734-763-5280
Practice Address - Fax:734-763-3453
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017077122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI195816287OtherBCBS OF MI MED SURGICAL
MI4125504Medicaid
MID170770OtherBCBS OF MI DENTAL
MI4125522Medicaid
MI0N65440011Medicare PIN
MI4125522Medicaid