Provider Demographics
NPI:1891796363
Name:SCHOUTEN, JOSEPH A (DDS,MAGD,MASDC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:SCHOUTEN
Suffix:
Gender:M
Credentials:DDS,MAGD,MASDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 E NORTHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-8415
Mailing Address - Country:US
Mailing Address - Phone:920-739-3887
Mailing Address - Fax:920-739-0353
Practice Address - Street 1:1225 E NORTHLAND AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-8415
Practice Address - Country:US
Practice Address - Phone:920-739-3887
Practice Address - Fax:920-739-0353
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001547-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice