Provider Demographics
NPI:1184899148
Name:ANDREUCCI, WAYNE J (DDS)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:J
Last Name:ANDREUCCI
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 1:5017 GREEN BAY RD
Mailing Address - Street 2:STE 136
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1782
Mailing Address - Country:US
Mailing Address - Phone:262-652-6121
Mailing Address - Fax:262-652-2026
Practice Address - Street 1:5017 GREEN BAY RD
Practice Address - Street 2:STE 136
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1782
Practice Address - Country:US
Practice Address - Phone:262-652-6121
Practice Address - Fax:262-652-2026
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001446-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist