Provider Demographics
NPI:1447334347
Name:KREBS, LISA MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MICHELLE
Last Name:KREBS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 STATE HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-8796
Mailing Address - Country:US
Mailing Address - Phone:715-627-1000
Mailing Address - Fax:715-627-7123
Practice Address - Street 1:408 STATE HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-8796
Practice Address - Country:US
Practice Address - Phone:715-627-1000
Practice Address - Fax:715-627-7123
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIFK0921076OtherDEA NUMBER