Provider Demographics
NPI:1811066343
Name:BUCHOLTZ, NEAL ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:ROBERT
Last Name:BUCHOLTZ
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 1:15350 W NATIONAL AVENUE
Mailing Address - Street 2:SUITE #121
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-5158
Mailing Address - Country:US
Mailing Address - Phone:262-784-7115
Mailing Address - Fax:
Practice Address - Street 1:15350 W NATIONAL AVENUE
Practice Address - Street 2:SUITE #121
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5158
Practice Address - Country:US
Practice Address - Phone:262-784-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001749015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist