Provider Demographics
NPI:1063826659
Name:TREICHEL, BLAKE C (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:C
Last Name:TREICHEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E TOWNE DR
Mailing Address - Street 2:
Mailing Address - City:HORTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54944-9303
Mailing Address - Country:US
Mailing Address - Phone:920-779-4533
Mailing Address - Fax:
Practice Address - Street 1:230 E TOWNE DR
Practice Address - Street 2:
Practice Address - City:HORTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54944-9303
Practice Address - Country:US
Practice Address - Phone:920-779-4533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7267 - 15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist