Provider Demographics
NPI:1992069611
Name:STRIEBEL, JONATHAN ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ROBERT
Last Name:STRIEBEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 S DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-2159
Mailing Address - Country:US
Mailing Address - Phone:937-293-4261
Mailing Address - Fax:937-293-1144
Practice Address - Street 1:4031 S DIXIE DR
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-2159
Practice Address - Country:US
Practice Address - Phone:937-293-4261
Practice Address - Fax:937-293-1144
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0237881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice