Individual
MARK A LETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1112 LINCOLN STREET, KEWAUNEE, WI 54216
(920) 388-5200
(920) 388-5202
Mailing address
PO BOX 198, 1112 LINCOLN STREET, KEWAUNEE, WI 54216-0198
(920) 388-5200
(920) 388-5202
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3865
WI
Other
Enumeration date
10/04/2006
Last updated
07/08/2007
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