Healthcare Provider Details

I. General information

NPI: 1013910637
Provider Name (Legal Business Name): DAVID MICHAEL PREBLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E CHICAGO AVE SUITE 1800
CHICAGO IL
60611-2637
US

IV. Provider business mailing address

211 E CHICAGO AVE SUITE 1800
CHICAGO IL
60611-2637
US

V. Phone/Fax

Practice location:
  • Phone: 312-440-2756
  • Fax: 312-440-2520
Mailing address:
  • Phone: 312-440-2756
  • Fax: 312-440-2520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN12044
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: