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General NPI Number Information
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NPI Number | 1922750280
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Entity Type | Individual
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Provider Name | KATELYN KLEUTSCH DMD
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Gender | Female
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 315 MINER AVE W
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City | LADYSMITH
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State | WI
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Zip | 54848-1725
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Country | US
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Telephone | 715-532-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 1007 SHADY LN
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City | LADYSMITH
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State | WI
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Zip | 54848-1478
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Country | US
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Telephone | 715-661-3148
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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 | 6001106-15
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License Number State | WI
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