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General NPI Number Information
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NPI Number | 1841411659
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Entity Type | Organization
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Legal Business Name | DAVID E KRIGBAUM DDS SC
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 2620 STEWART AVE SUITE 218
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City | WAUSAU
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State | WI
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Zip | 54401-4170
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Country | US
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Telephone | 715-842-8811
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Fax | 715-848-5109
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Provider Business Mailing Address
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Address Line | 2620 STEWART AVE SUITE 218
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City | WAUSAU
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State | WI
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Zip | 54401-4170
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID KRIGBAUM
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Credential |
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Telephone | 715-842-8811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 4501
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License Number State | WI
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