Provider Demographics
NPI:1578132643
Name:LV, QINGZE (DMD)
Entity Type:Individual
Prefix:DR
First Name:QINGZE
Middle Name:
Last Name:LV
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SHERMAN AVE W
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-1734
Mailing Address - Country:US
Mailing Address - Phone:920-563-7323
Mailing Address - Fax:
Practice Address - Street 1:201 SHERMAN AVE W
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1734
Practice Address - Country:US
Practice Address - Phone:920-563-7323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002552-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice