Provider Demographics
NPI:1578638037
Name:VOIGT, RICHARD E (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:VOIGT
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 1:707 W MORELAND BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2400
Mailing Address - Country:US
Mailing Address - Phone:262-548-9600
Mailing Address - Fax:
Practice Address - Street 1:707 W MORELAND BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-2400
Practice Address - Country:US
Practice Address - Phone:262-548-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1566G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33368200Medicaid