Provider Demographics
NPI:1821183393
Name:MYHRE, WAYNE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:E
Last Name:MYHRE
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 1:300 WATER AVENUE
Mailing Address - Street 2:P. O. BOX425
Mailing Address - City:HILLSBORO
Mailing Address - State:WI
Mailing Address - Zip Code:54634-0425
Mailing Address - Country:US
Mailing Address - Phone:608-489-2727
Mailing Address - Fax:608-489-4356
Practice Address - Street 1:300 WATER AVENUE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:WI
Practice Address - Zip Code:54634-0425
Practice Address - Country:US
Practice Address - Phone:608-489-2727
Practice Address - Fax:608-489-4356
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2391122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist