Healthcare Provider Details

I. General information

NPI: 1154446508
Provider Name (Legal Business Name): WILLIAM D BETHKE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 STEIN BLVD
EAU CLAIRE WI
54701-6997
US

IV. Provider business mailing address

3131 STEIN BLVD
EAU CLAIRE WI
54701-6997
US

V. Phone/Fax

Practice location:
  • Phone: 715-835-7172
  • Fax: 715-835-5841
Mailing address:
  • Phone: 715-835-7172
  • Fax: 715-835-5841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3548015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: