Healthcare Provider Details

I. General information

NPI: 1922750280
Provider Name (Legal Business Name): KATELYN KLEUTSCH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MINER AVE W
LADYSMITH WI
54848-1725
US

IV. Provider business mailing address

1007 SHADY LN
LADYSMITH WI
54848-1478
US

V. Phone/Fax

Practice location:
  • Phone: 715-532-2500
  • Fax:
Mailing address:
  • Phone: 715-661-3148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6001106-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: