Healthcare Provider Details

I. General information

NPI: 1609871755
Provider Name (Legal Business Name): DENNIS J FEHRMAN D.D.S., M.S., S.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/18/2006
Reactivation Date: 04/06/2006

III. Provider practice location address

1815 SCHOFIELD AVE
SCHOFIELD WI
54476-2360
US

IV. Provider business mailing address

1815 SCHOFIELD AVE
SCHOFIELD WI
54476-2360
US

V. Phone/Fax

Practice location:
  • Phone: 715-359-1910
  • Fax: 715-355-1815
Mailing address:
  • Phone: 715-359-1910
  • Fax: 715-355-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3531
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: