Healthcare Provider Details

I. General information

NPI: 1083899496
Provider Name (Legal Business Name): JEFFREY SCOTT RYTHER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S WEBSTER AVE SUITE 8
GREEN BAY WI
54301-2281
US

IV. Provider business mailing address

1901 SOUTH WEBSTER SUITE 8
GREEN BAY WI
54301
US

V. Phone/Fax

Practice location:
  • Phone: 920-437-1499
  • Fax: 920-437-5333
Mailing address:
  • Phone: 920-437-1499
  • Fax: 920-437-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2724
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: