Individual
DR. BRUCE A BEVERSDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
200 S CHERRY ST, WITTENBERG, WI 54499
(715) 253-2694
(715) 253-3838
Mailing address
PO BOX H, WITTENBERG, WI 54499
(715) 253-2694
(715) 253-3838
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5002135
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33378100
BADGERCARE MA
WI
Enumeration date
03/17/2008
Last updated
03/17/2008
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