1861019853 NPI number — DR. MARGARET EBER DDS

Table of content: DR. MARGARET EBER DDS (NPI 1861019853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861019853 NPI number — DR. MARGARET EBER DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EBER
Provider First Name:
MARGARET
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861019853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 N MAYFAIR RD STE 311
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUWATOSA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53222-3219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5061 W 111TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALSIP
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60803-6004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-422-6655
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  019.032717 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)