Provider Demographics
NPI:1376637579
Name:PLAUTZ, HENRY STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:STEVEN
Last Name:PLAUTZ
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 1:400 E. CASTLEBURY LN
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-6331
Mailing Address - Country:US
Mailing Address - Phone:920-830-2495
Mailing Address - Fax:
Practice Address - Street 1:2410 E. EVERGREEN DR.
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-6331
Practice Address - Country:US
Practice Address - Phone:920-832-9500
Practice Address - Fax:920-832-9490
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU36668Medicare UPIN