Healthcare Provider Details

I. General information

NPI: 1528823069
Provider Name (Legal Business Name): DAWN MARIE CHAMBERS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN MARIE TROIA RDH

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W3275 WOLF RIVER DR
KESHENA WI
54135-9202
US

IV. Provider business mailing address

N5285 ASH LN
SHAWANO WI
54166-5325
US

V. Phone/Fax

Practice location:
  • Phone: 715-799-3960
  • Fax:
Mailing address:
  • Phone: 608-234-2484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number6822-16
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: