Provider Demographics
NPI:1720126352
Name:EBLEN, DONALD W (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:W
Last Name:EBLEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:J
Other - Last Name:SALMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1015 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8010
Mailing Address - Country:US
Mailing Address - Phone:812-437-1015
Mailing Address - Fax:812-401-1013
Practice Address - Street 1:1015 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8010
Practice Address - Country:US
Practice Address - Phone:812-437-1015
Practice Address - Fax:812-401-1013
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009288A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice