Provider Demographics
NPI:1356307359
Name:HOUTCHENS, NANCY JANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JANE
Last Name:HOUTCHENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7533 22ND AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143
Mailing Address - Country:US
Mailing Address - Phone:262-654-4553
Mailing Address - Fax:262-654-7530
Practice Address - Street 1:7533 22ND AVE
Practice Address - Street 2:STE 100
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143
Practice Address - Country:US
Practice Address - Phone:262-654-4553
Practice Address - Fax:262-654-7530
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33380500Medicaid