Provider Demographics
NPI:1376706150
Name:GIEBENHAIN, MICHAEL E
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:GIEBENHAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:E
Other - Last Name:GIEBENHAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:N7068 W KENYON RD
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-5649
Mailing Address - Country:US
Mailing Address - Phone:612-816-8429
Mailing Address - Fax:
Practice Address - Street 1:N6625 COUNTY ROAD A
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-5852
Practice Address - Country:US
Practice Address - Phone:715-284-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6272-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist