Provider Demographics
NPI:1154446508
Name:BETHKE, WILLIAM D (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:BETHKE
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 1:3131 STEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6997
Mailing Address - Country:US
Mailing Address - Phone:715-835-7172
Mailing Address - Fax:715-835-5841
Practice Address - Street 1:3131 STEIN BLVD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6997
Practice Address - Country:US
Practice Address - Phone:715-835-7172
Practice Address - Fax:715-835-5841
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35480151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33483500OtherWI MA