Individual
DR. TIMOTHY BREKKE DURTSCHE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
615 10TH ST S, LA CROSSE, WI 54601-4768
(608) 784-7319
(608) 784-4384
Mailing address
615 10TH ST S, LA CROSSE, WI 54601-4768
(608) 784-7319
(608) 784-4384
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2244
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33388200(PERFORMING)
—
WI
05
—
38365100 (BILLING#)
—
WI
Enumeration date
06/09/2005
Last updated
07/08/2007
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