Provider Demographics
NPI:1427402361
Name:DECREMER, KIRK (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:
Last Name:DECREMER
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 1:2121 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2290
Mailing Address - Country:US
Mailing Address - Phone:920-435-1998
Mailing Address - Fax:920-435-1399
Practice Address - Street 1:2121 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2290
Practice Address - Country:US
Practice Address - Phone:920-435-1998
Practice Address - Fax:920-435-1399
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001330-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist