Provider Demographics
NPI:1508949082
Name:GARY L KAEFER DDS SC
Entity Type:Organization
Organization Name:GARY L KAEFER DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-463-2882
Mailing Address - Street 1:302 SOUTH PINE ST
Mailing Address - Street 2:
Mailing Address - City:GRANTSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:54840
Mailing Address - Country:US
Mailing Address - Phone:715-463-2882
Mailing Address - Fax:715-463-2885
Practice Address - Street 1:302 SOUTH PINE ST
Practice Address - Street 2:
Practice Address - City:GRANTSBURG
Practice Address - State:WI
Practice Address - Zip Code:54840
Practice Address - Country:US
Practice Address - Phone:715-463-2882
Practice Address - Fax:715-463-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50019131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty