Individual
DR. JACK RALPH WILLERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1835 W POINTE DR, OSHKOSH, WI 54902-4174
(920) 231-3140
(920) 231-5040
Mailing address
1835 W POINTE DR, OSHKOSH, WI 54902-4174
(920) 231-3140
(920) 231-5040
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5001833
WI
Other
Enumeration date
01/30/2007
Last updated
07/08/2007
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