Individual
DR. JERRY LEE UTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1212 HORTON ST, LA CROSSE, WI 54601-6372
(608) 788-1090
Mailing address
401 GILLETTE ST, APT 303, LA CROSSE, WI 54603-4208
(608) 498-1965
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6072
WI
1223G0001X
General Practice Dentistry
D11374
MN
Other
Enumeration date
04/24/2007
Last updated
07/08/2007
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