Provider Demographics
NPI:1760628887
Name:MAUTHE, WILLIAM C (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:MAUTHE
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 1:101 CAMELOT DR STE 3
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-8048
Mailing Address - Country:US
Mailing Address - Phone:920-921-1244
Mailing Address - Fax:920-921-2192
Practice Address - Street 1:101 CAMELOT DR STE 3
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-8048
Practice Address - Country:US
Practice Address - Phone:920-921-1244
Practice Address - Fax:920-921-2192
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50001891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice