Provider Demographics
NPI:1689798027
Name:KRUEGER, THOEDOER (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOEDOER
Middle Name:
Last Name:KRUEGER
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 1:501 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:HORICON
Mailing Address - State:WI
Mailing Address - Zip Code:53032-1246
Mailing Address - Country:US
Mailing Address - Phone:920-485-4831
Mailing Address - Fax:
Practice Address - Street 1:501 E LAKE ST
Practice Address - Street 2:
Practice Address - City:HORICON
Practice Address - State:WI
Practice Address - Zip Code:53032-1246
Practice Address - Country:US
Practice Address - Phone:920-485-4831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice