Individual
DR. AUSTIN ALLEN IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1349 W GRAND AVE, PORT WASHINGTON, WI 53074-2043
(262) 284-5505
Mailing address
1349 W GRAND AVE, PORT WASHINGTON, WI 53074-2043
(262) 284-5505
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1002153-15
WI
Other
Enumeration date
07/09/2019
Last updated
04/07/2023
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