Provider Demographics
NPI:1295815066
Name:TESKE, DAVID M (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:TESKE
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 1:700 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4052
Mailing Address - Country:US
Mailing Address - Phone:920-435-9400
Mailing Address - Fax:920-964-1090
Practice Address - Street 1:700 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4052
Practice Address - Country:US
Practice Address - Phone:920-435-9400
Practice Address - Fax:920-964-1090
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50008410151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice