Provider Demographics
NPI:1003262403
Name:HULDERMAN, MACAIRE CLAIRE (DDS)
Entity Type:Individual
Prefix:
First Name:MACAIRE
Middle Name:CLAIRE
Last Name:HULDERMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MACAIRE
Other - Middle Name:CLAIRE
Other - Last Name:THIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:9000 W. WISCOSNIN AVENUE MS 958
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-7615
Mailing Address - Fax:414-266-6238
Practice Address - Street 1:9000 W. WISCONSIN AVE.
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-266-2040
Practice Address - Fax:414-266-5677
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30025263122300000X, 1223P0221X
WI1001353-151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1003262403Medicaid
OH0276108Medicaid