Provider Demographics
NPI:1649376724
Name:EXNER, ALBERT CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:CHARLES
Last Name:EXNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:A.
Other - Middle Name:CHARLES
Other - Last Name:EXNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2314 N GRANDVIEW BLVD
Mailing Address - Street 2:SUITE #203
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1675
Mailing Address - Country:US
Mailing Address - Phone:262-542-1513
Mailing Address - Fax:262-549-9195
Practice Address - Street 1:2314 N GRANDVIEW BLVD
Practice Address - Street 2:SUITE #203
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1675
Practice Address - Country:US
Practice Address - Phone:262-542-1513
Practice Address - Fax:262-549-9195
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice