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General NPI Number Information
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NPI Number | 1891300455
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Entity Type | Individual
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Provider Name | ADAM T. QUETSCH DDS
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Gender | Male
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 819 SUMMIT AVE
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City | OCONOMOWOC
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State | WI
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Zip | 53066-3998
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Country | US
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Telephone | 262-333-0149
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Fax |
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Provider Business Mailing Address
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Address Line | 1607A N ASTOR ST
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City | MILWAUKEE
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State | WI
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Zip | 53202-2107
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Country | US
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Telephone | 630-770-4457
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1002435-15
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License Number State | WI
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