Healthcare Provider Details

I. General information

NPI: 1215961685
Provider Name (Legal Business Name): SCOTT MARTIN BEHRINGER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 N 18TH ST
MANITOWOC WI
54220-1858
US

IV. Provider business mailing address

1602 N 18TH ST
MANITOWOC WI
54220-1858
US

V. Phone/Fax

Practice location:
  • Phone: 920-682-9131
  • Fax: 920-682-9799
Mailing address:
  • Phone: 920-682-9131
  • Fax: 920-682-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5001788
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: