Healthcare Provider Details

I. General information

NPI: 1124346721
Provider Name (Legal Business Name): BETH ANN TETZNER DENTAL HYGIENIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN ST W SIDE B
ASHLAND WI
54806-1619
US

IV. Provider business mailing address

30840 WANNEBO RD
WASHBURN WI
54891-5891
US

V. Phone/Fax

Practice location:
  • Phone: 715-685-2200
  • Fax: 715-685-2202
Mailing address:
  • Phone: 715-685-2200
  • Fax: 715-685-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number10685016
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: