Provider Demographics
NPI:1609871755
Name:FEHRMAN, DENNIS J (DDS, MS, SC)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:FEHRMAN
Suffix:
Gender:M
Credentials:DDS, MS, SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 SCHOFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2360
Mailing Address - Country:US
Mailing Address - Phone:715-359-1910
Mailing Address - Fax:715-355-1815
Practice Address - Street 1:1815 SCHOFIELD AVE
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-2360
Practice Address - Country:US
Practice Address - Phone:715-359-1910
Practice Address - Fax:715-355-1815
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
WI35311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3531OtherSTATE DENTAL LICENSE