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MR. EUGENE RICHARD UTRIE DDS
General Practice >> Dentist >> Dental ProvidersRegistrant NPI Number: 1669531943
Individual Registrant:MR. EUGENE RICHARD UTRIE DDS
Gender: M
Not Sole Proprietor
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: --
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: --
Tel: 920-478-3636 Fax: --
Registration Information:
NPI: 1669531943
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1223G0001X | Dental Providers Dentist General Practice | WI | 5000697 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| LICENSE | 5000697 | WI | 01 |
| DRUG DEA | AU3556985 | 01 |
