Provider Demographics
NPI:1962632778
Name:TAIBL, ERIC (DDS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:TAIBL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:W
Other - Last Name:TAIBL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2727 N GRANDVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-6100
Mailing Address - Country:US
Mailing Address - Phone:262-542-6755
Mailing Address - Fax:
Practice Address - Street 1:2727 N GRANDVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-6100
Practice Address - Country:US
Practice Address - Phone:262-542-6755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI64171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice