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Individual

DR. KALI ROSE DISTERHOFT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
33 E WALDO BLVD, MANITOWOC, WI 54220-2900
(920) 682-0115
Mailing address
622 PENNSYLVANIA AVE UNIT 504, SHEBOYGAN, WI 53081-4662

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1002654-15
WI
122300000X
Dentist
DDS-09919
IA

Other

Enumeration date
07/06/2021
Last updated
07/25/2021
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