Provider Demographics
NPI:1770730533
Name:DARKOW, EUGENE ARTHUR JR (DDS)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:ARTHUR
Last Name:DARKOW
Suffix:JR
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 1:114 HAYLETT ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3830
Mailing Address - Country:US
Mailing Address - Phone:920-725-1111
Mailing Address - Fax:
Practice Address - Street 1:114 HAYLETT ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3830
Practice Address - Country:US
Practice Address - Phone:920-725-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-24
Last Update Date:2008-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33469800Medicaid