Provider Demographics
NPI:1396802211
Name:EBINGER, JOHN CHARLES (DDS MSD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CHARLES
Last Name:EBINGER
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:5739 3RD AVE
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248
Mailing Address - Country:US
Mailing Address - Phone:360-384-3713
Mailing Address - Fax:360-384-3713
Practice Address - Street 1:5739 3RD AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248
Practice Address - Country:US
Practice Address - Phone:360-384-3713
Practice Address - Fax:360-384-3713
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA46111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
487048OtherUNITED CONCORDIA
WA5021407OtherOSHS