Provider Demographics
NPI:1770670309
Name:FUNKE, JAMES EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:FUNKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:EDWARD
Other - Last Name:FUNKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4701 WEST NATIONAL AVENUE WEST MILWAUKEE WISCONSIN
Mailing Address - Street 2:
Mailing Address - City:WEST MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3521
Mailing Address - Country:US
Mailing Address - Phone:414-645-7777
Mailing Address - Fax:414-645-5360
Practice Address - Street 1:4701 WEST NATIONAL AVENUE
Practice Address - Street 2:
Practice Address - City:WEST MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-3521
Practice Address - Country:US
Practice Address - Phone:414-645-7777
Practice Address - Fax:414-645-5360
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001319G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice