Provider Demographics
NPI:1629585021
Name:GRAMZ, BETH ANN (RDH)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:GRAMZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 ARMOUR RD STE B
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-3976
Mailing Address - Country:US
Mailing Address - Phone:262-719-8783
Mailing Address - Fax:
Practice Address - Street 1:856 ARMOUR RD STE B
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3976
Practice Address - Country:US
Practice Address - Phone:262-569-4990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5393124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist