Provider Demographics
NPI:1144349762
Name:TORGERSON, DONALD ROY (DDS)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:ROY
Last Name:TORGERSON
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 1:207 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-3019
Mailing Address - Country:US
Mailing Address - Phone:715-234-3511
Mailing Address - Fax:
Practice Address - Street 1:207 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-3019
Practice Address - Country:US
Practice Address - Phone:715-234-3511
Practice Address - Fax:715-736-0716
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001430G0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33655000Medicaid