Provider Demographics
NPI:1336851765
Name:ABFALL, CALEB JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CALEB
Middle Name:JOSEPH
Last Name:ABFALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 S ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-4608
Mailing Address - Country:US
Mailing Address - Phone:513-518-7690
Mailing Address - Fax:
Practice Address - Street 1:3071 VOYAGER DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-8352
Practice Address - Country:US
Practice Address - Phone:920-465-9887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001111-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice