Provider Demographics
NPI:1922267434
Name:DUENK, JEFFREY JON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JON
Last Name:DUENK
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 1:608 S ELM
Mailing Address - Street 2:PO BOX 320
Mailing Address - City:CEDAR GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53013
Mailing Address - Country:US
Mailing Address - Phone:920-668-8546
Mailing Address - Fax:
Practice Address - Street 1:608 S ELM
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:WI
Practice Address - Zip Code:53013
Practice Address - Country:US
Practice Address - Phone:920-668-8546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3595015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist