Individual
JACK BIRCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8400
Mailing address
1801 W WISCONSIN AVE, MILWAUKEE, WI 53233-2186
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6001525
WI
Other
Enumeration date
04/27/2024
Last updated
07/30/2025
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