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MR. EUGENE RICHARD UTRIE DDS

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1669531943

Individual Registrant:
MR. EUGENE RICHARD UTRIE DDS
Gender: M
Not Sole Proprietor

Location and contact information for practice:
144 WEST MADISON STREET PROFESSIONAL BUILDING WATERLOO, WI 53594-1397 US
Tel: 920-478-3636  Fax: --

Contact information for business:
144 WEST MADISON STREET PROFESSIONAL BUILDING WATERLOO, WI 53594-1397 US
Tel: 920-478-3636  Fax: --

Registration Information:
NPI: 1669531943
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
WI5000697

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
LICENSE5000697WI01
DRUG DEAAU355698501




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