MEDICARE: DAYNA DECKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	1003948-16	WI

General Provider Information

NPI Number	:	1346022043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAYNA DECKER

Provider Business Mailing Address
First Line	:	1975 E HIDDEN CREEK CT APT 204
Second Line	:
City	:	OAK CREEK
State	:	WI
Zip	:	53154-4487
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2561 N 29TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-3116
Country	:	US
Telephone Number	:	414-372-4007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2023
Last Update Date	:	10/17/2023

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Directions to “ DAYNA DECKER ” Practice Location

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