Provider Demographics
NPI:1760596688
Name:BEUTLER, BARBARA J (DDS)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:J
Last Name:BEUTLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:J
Other - Last Name:LANZL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:450 OLD ABE RD
Mailing Address - Street 2:PO BOX 450
Mailing Address - City:LAC DU FLAMBEAU
Mailing Address - State:WI
Mailing Address - Zip Code:54538-9682
Mailing Address - Country:US
Mailing Address - Phone:715-588-4269
Mailing Address - Fax:715-588-2269
Practice Address - Street 1:450 OLD ABE RD
Practice Address - Street 2:
Practice Address - City:LAC DU FLAMBEAU
Practice Address - State:WI
Practice Address - Zip Code:54538-9682
Practice Address - Country:US
Practice Address - Phone:715-588-4269
Practice Address - Fax:715-588-2269
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5083015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI58357OtherSECURITY HEALTH PLAN
WI33753600Medicaid