Provider Demographics
NPI:1568167633
Name:HERFEL, KELSI ANN
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:ANN
Last Name:HERFEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELSI
Other - Middle Name:ANN
Other - Last Name:SALZWEDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9921 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-2607
Mailing Address - Country:US
Mailing Address - Phone:608-350-7899
Mailing Address - Fax:
Practice Address - Street 1:440 SCIENCE DR STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1064
Practice Address - Country:US
Practice Address - Phone:608-308-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001225-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice