Provider Demographics
NPI:1396496881
Name:DUSTIN A. EBNER D.D.S. PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DUSTIN A. EBNER D.D.S. PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:EBNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-424-6421
Mailing Address - Street 1:6605 W 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4905
Mailing Address - Country:US
Mailing Address - Phone:303-424-6421
Mailing Address - Fax:
Practice Address - Street 1:6605 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4905
Practice Address - Country:US
Practice Address - Phone:303-424-6421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-16
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental