Individual
DALE WAYNE WILLOUGHBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6707 39TH AVE, KENOSHA, WI 53142-7125
(262) 658-3559
(262) 658-0276
Mailing address
6707 39TH AVE, KENOSHA, WI 53142-7125
(262) 658-3559
(262) 653-1142
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4998-015
WI
Other
Enumeration date
06/09/2005
Last updated
06/02/2022
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