Healthcare Provider Details

I. General information

NPI: 1336258557
Provider Name (Legal Business Name): ESSER, KRUEGER & BORJA DDS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E LAKE ST
HORICON WI
53032-1246
US

IV. Provider business mailing address

501 E LAKE ST
HORICON WI
53032-1246
US

V. Phone/Fax

Practice location:
  • Phone: 920-485-4831
  • Fax: 920-485-6780
Mailing address:
  • Phone: 920-485-4831
  • Fax: 920-485-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SHERRI HINKLEY
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 920-485-4831