MEDICARE: DR. PAIGE CHRISTINE KITZING DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6001562	WI

General Provider Information

NPI Number	:	1932941887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAIGE CHRISTINE KITZING DMD

Provider Business Mailing Address
First Line	:	1429 MEADOWLANE AVE
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-4421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5780 N PORT WASHINGTON RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53217-4510
Country	:	US
Telephone Number	:	414-539-5600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/24/2024

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