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General NPI Number Information
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NPI Number | 1447986161
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Entity Type | Individual
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Provider Name | ANDREW C DE WET DDS
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Gender | Male
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Dates
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Enumeration Date | 07/26/2022
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 903 E AIRPORT RD
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City | MENASHA
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State | WI
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Zip | 54952-1942
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Country | US
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Telephone | 920-215-4160
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Fax |
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Provider Business Mailing Address
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Address Line | 161 S RIVERHEATH WAY APT 407
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City | APPLETON
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State | WI
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Zip | 54915-8414
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Country | US
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Telephone | 920-268-5978
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 600103615
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License Number State | WI
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