=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467568709
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER WILLIAM PAQUETTE DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205-B DIVISON STREET
-----------------------------------------------------
City | MAUSTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53948-2110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-847-5572
-----------------------------------------------------
Fax | 608-847-3712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 926 ELM STREET
-----------------------------------------------------
City | MAUSTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53948-2110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-847-5978
-----------------------------------------------------
Fax | 608-847-3712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2634
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2634
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------