MEDICARE: DR. JOHN J EBELING II DDS

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	13948	MO

General Provider Information

NPI Number	:	1851329379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN J EBELING II DDS

Provider Business Mailing Address
First Line	:	1360 S 5TH ST
Second Line	:	SUITE 214
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2449
Country	:	US
Telephone Number	:	636-946-6747
Fax Number	:	636-946-7629

Provider Business Practice Location Address
First Line	:	1360 S 5TH ST
Second Line	:	SUITE 214
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2449
Country	:	US
Telephone Number	:	636-946-6747
Fax Number	:	636-946-7629

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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