Healthcare Provider Details

I. General information

NPI: 1295725638
Provider Name (Legal Business Name): JOHN H BETZ DDS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 10TH ST S
LA CROSSE WI
54601
US

IV. Provider business mailing address

615 10TH ST S
LA CROSSE WI
54601
US

V. Phone/Fax

Practice location:
  • Phone: 608-782-4054
  • Fax: 608-782-4054
Mailing address:
  • Phone: 608-782-4054
  • Fax: 608-782-2198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5000873
License Number StateWI

VIII. Authorized Official

Name: MR. JOHN H BETZ
Title or Position: SC PRES
Credential: DDS
Phone: 608-782-4054