Healthcare Provider Details

I. General information

NPI: 1336908631
Provider Name (Legal Business Name): WILLIAM JAMES DUMMER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W SILVER SPRING DR STE 3
GLENDALE WI
53209-4217
US

IV. Provider business mailing address

2501 W SILVER SPRING DR STE 3
GLENDALE WI
53209-4217
US

V. Phone/Fax

Practice location:
  • Phone: 414-363-9980
  • Fax: 414-363-9981
Mailing address:
  • Phone: 414-363-9980
  • Fax: 414-363-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019035929
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6002094
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: