Provider Demographics
NPI:1700800810
Name:CHABALOWSKI, ROBERT RICHARD (DDS)
Entity Type:Individual
Prefix:PROF
First Name:ROBERT
Middle Name:RICHARD
Last Name:CHABALOWSKI
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 1:58 RACINE ST.POBOX 515
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-0515
Mailing Address - Country:US
Mailing Address - Phone:920-725-8213
Mailing Address - Fax:
Practice Address - Street 1:58 RACINE ST
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-3154
Practice Address - Country:US
Practice Address - Phone:920-725-8213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1457G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice