Healthcare Provider Details

I. General information

NPI: 1710603808
Provider Name (Legal Business Name): JUDITH ANNE GEFROH RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 S HASTINGS WAY
EAU CLAIRE WI
54701-3426
US

IV. Provider business mailing address

15735 W US HIGHWAY 63
HAYWARD WI
54843-6475
US

V. Phone/Fax

Practice location:
  • Phone: 715-861-7901
  • Fax: 715-861-7905
Mailing address:
  • Phone: 715-934-0710
  • Fax: 715-598-4881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number7001061
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: