Provider Demographics
NPI:1154585594
Name:JEFFREY S. WITHUSKI & PAULA SABBE DDS
Entity type:Organization
Organization Name:JEFFREY S. WITHUSKI & PAULA SABBE DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WITHUSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-642-8566
Mailing Address - Street 1:103 9TH ST N STE 2
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4343
Mailing Address - Country:US
Mailing Address - Phone:701-642-8566
Mailing Address - Fax:701-642-1111
Practice Address - Street 1:103 9TH ST N STE 2
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4343
Practice Address - Country:US
Practice Address - Phone:701-642-8566
Practice Address - Fax:701-642-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41107Medicaid
1807OtherBCBS
ND984022200OtherMINNESOTA MEDICAL ASSISTANCE