Healthcare Provider Details

I. General information

NPI: 1578879532
Provider Name (Legal Business Name): KELSEY MARIE PATTON HOSTETLER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 S MAIN ST
VERONA WI
53593-1470
US

IV. Provider business mailing address

271 S MAIN ST
VERONA WI
53593-1470
US

V. Phone/Fax

Practice location:
  • Phone: 608-845-6612
  • Fax:
Mailing address:
  • Phone: 608-845-6612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7161
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901020299
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: