Provider Demographics
NPI:1851377220
Name:CZYZ-KLEMENS, ANNE MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:CZYZ-KLEMENS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 BEL AIRE CT
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5015
Mailing Address - Country:US
Mailing Address - Phone:920-499-2121
Mailing Address - Fax:920-499-7644
Practice Address - Street 1:1052 BEL AIRE CT
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5015
Practice Address - Country:US
Practice Address - Phone:920-499-2121
Practice Address - Fax:920-499-7644
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice