Provider Demographics
NPI:1053412460
Name:NORMAN W EBNER DDS PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:NORMAN W EBNER DDS PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:EBNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:303-424-6421
Mailing Address - Street 1:6605 W 38TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033
Mailing Address - Country:US
Mailing Address - Phone:303-424-6421
Mailing Address - Fax:303-456-7682
Practice Address - Street 1:6605 W 38TH AVENUE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033
Practice Address - Country:US
Practice Address - Phone:303-424-6421
Practice Address - Fax:303-456-7682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5448122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty