Provider Demographics
NPI:1205815941
Name:FROSCH, TERYL J (RDH)
Entity Type:Individual
Prefix:
First Name:TERYL
Middle Name:J
Last Name:FROSCH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-2041
Mailing Address - Country:US
Mailing Address - Phone:608-643-8505
Mailing Address - Fax:608-643-8097
Practice Address - Street 1:1250 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-2041
Practice Address - Country:US
Practice Address - Phone:608-643-8505
Practice Address - Fax:608-643-8097
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4215-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist