Provider Demographics
NPI:1811025364
Name:DOUSMAN FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DOUSMAN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHAEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-965-3662
Mailing Address - Street 1:261 N. MAIN STREET
Mailing Address - Street 2:P.O. BOX 187
Mailing Address - City:DOUSMAN
Mailing Address - State:WI
Mailing Address - Zip Code:53118-0187
Mailing Address - Country:US
Mailing Address - Phone:262-965-3662
Mailing Address - Fax:262-965-3627
Practice Address - Street 1:261 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:DOUSMAN
Practice Address - State:WI
Practice Address - Zip Code:53118-0187
Practice Address - Country:US
Practice Address - Phone:262-965-3662
Practice Address - Fax:262-965-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty