Individual
BENJAMIN GAUTHIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12455 W CAPITOL DR, BROOKFIELD, WI 53005-2461
(262) 792-1100
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(315) 454-6000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6618-15
WI
Other
Enumeration date
09/29/2010
Last updated
09/29/2010
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