Provider Demographics
NPI:1265547442
Name:ROWE, DANN R (DDS)
Entity type:Individual
Prefix:MR
First Name:DANN
Middle Name:R
Last Name:ROWE
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:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:LUCK
Mailing Address - State:WI
Mailing Address - Zip Code:54853
Mailing Address - Country:US
Mailing Address - Phone:715-472-2211
Mailing Address - Fax:715-472-2211
Practice Address - Street 1:308 1ST ST S
Practice Address - Street 2:
Practice Address - City:LUCK
Practice Address - State:WI
Practice Address - Zip Code:54853
Practice Address - Country:US
Practice Address - Phone:715-472-2211
Practice Address - Fax:715-472-2211
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33571700Medicaid