Provider Demographics
NPI:1952432452
Name:MABEUS, DAVID MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:MABEUS
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 1:101 W. MCMILLAN ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-1039
Mailing Address - Country:US
Mailing Address - Phone:715-384-5444
Mailing Address - Fax:715-384-9019
Practice Address - Street 1:101 W. MCMILLAN ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-1039
Practice Address - Country:US
Practice Address - Phone:715-384-5444
Practice Address - Fax:715-384-9019
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice