Healthcare Provider Details

I. General information

NPI: 1427385483
Provider Name (Legal Business Name): GOTTFRIED HOHM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N50W34770 WISCONSIN AVE
OKAUCHEE WI
53069-9750
US

IV. Provider business mailing address

N50W34770 WISCONSIN AVE
OKAUCHEE WI
53069-9750
US

V. Phone/Fax

Practice location:
  • Phone: 262-567-0770
  • Fax: 262-567-0851
Mailing address:
  • Phone: 262-567-0770
  • Fax: 262-567-0851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3213-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: