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General NPI Number Information
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NPI Number | 1871616888
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Entity Type | Organization
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Legal Business Name | SOUTH EAST WISCONSIN ENDODONTIC ASSOCIATES
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 4707 WASHINGTON RD.
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City | KENOSHA
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State | WI
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Zip | 53144
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Country | US
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Telephone | 262-658-9140
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Fax |
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Provider Business Mailing Address
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Address Line | 4707 WASHINGTON RD.
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City | KENOSHA
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State | WI
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Zip | 53144
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Country | US
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Telephone | 262-658-9140
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | JAMES K. KREUTZER
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Credential |
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Telephone | 262-658-9140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 1984G
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License Number State | WI
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