Individual
SETH EBBEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
801 S PAULINA ST, CHICAGO, IL 60612-7210
(312) 996-7555
Mailing address
540 N 94TH ST, MILWAUKEE, WI 53226-4432
(630) 313-9440
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
019.032241
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2019
Last updated
07/09/2019
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