Provider Demographics
NPI:1922485994
Name:H. KEITH TREIBER, DDS FAMILY DENTISTRY P. C.
Entity Type:Organization
Organization Name:H. KEITH TREIBER, DDS FAMILY DENTISTRY P. C.
Other - Org Name:TAMARACK FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TREIBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-352-7752
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:412 LINCOLN AVE
Mailing Address - City:LAKEVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48850-0080
Mailing Address - Country:US
Mailing Address - Phone:989-352-7752
Mailing Address - Fax:989-352-8542
Practice Address - Street 1:412 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850-5004
Practice Address - Country:US
Practice Address - Phone:989-352-7752
Practice Address - Fax:989-352-8542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty