Facts
- Status
- A
- Credential
- DDS
- Type
- Individual
- Enumeration date
- 2022-06-08
- Last updated
- 2024-09-23
Licenses
- License WI
- 6000064-15
Location
- Practice location
- 3333 STANLEY ST
- City
- STEVENS POINT WI
- Postal code
- 544811323
- Phone
- 715-344-6499
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.