Provider Demographics
NPI:1811005481
Name:PUTNEY, JEFFREY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:G
Last Name:PUTNEY
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 1:12320 W OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2833
Mailing Address - Country:US
Mailing Address - Phone:414-321-6890
Mailing Address - Fax:414-321-6853
Practice Address - Street 1:12320 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2833
Practice Address - Country:US
Practice Address - Phone:414-321-6890
Practice Address - Fax:414-321-6853
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI00029421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice