Provider Demographics
NPI:1518691179
Name:KASTNER, ELYSE W (RDH)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:W
Last Name:KASTNER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:W
Other - Last Name:KUDRONOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2901 W BELTLINE HWY STE 120
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4231
Mailing Address - Country:US
Mailing Address - Phone:608-443-5500
Mailing Address - Fax:608-441-2385
Practice Address - Street 1:103 E FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1749
Practice Address - Country:US
Practice Address - Phone:608-935-5550
Practice Address - Fax:608-935-5168
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7001015-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist