MEDICARE: GARY N. KREBILL,DDS,PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11322	MI

General Provider Information

NPI Number	:	1760650972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY N. KREBILL,DDS,PC

Provider Business Mailing Address
First Line	:	4341 S WESTNEDGE AVE
Second Line	:	SUITE 2112
City	:	KALAMAZOO
State	:	MI
Zip	:	49008-3289
Country	:	US
Telephone Number	:	269-382-5040
Fax Number	:

Provider Business Practice Location Address
First Line	:	4341 S WESTNEDGE AVE
Second Line	:	SUITE 2112
City	:	KALAMAZOO
State	:	MI
Zip	:	49008-3289
Country	:	US
Telephone Number	:	269-382-5040
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GARY NEAL KREBILL
Credential	:	DDS
Telephone Number	:	269-323-9554

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	02/11/2008

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