Provider Demographics
NPI:1932151685
Name:DRS. ANDERSON & DURTSCHE, LTD.
Entity Type:Organization
Organization Name:DRS. ANDERSON & DURTSCHE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:BREKKE
Authorized Official - Last Name:DURTSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-784-7319
Mailing Address - Street 1:615 10TH ST S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4768
Mailing Address - Country:US
Mailing Address - Phone:608-784-7319
Mailing Address - Fax:608-784-4384
Practice Address - Street 1:615 10TH ST S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4768
Practice Address - Country:US
Practice Address - Phone:608-784-7319
Practice Address - Fax:608-784-4384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38365100 (BILLING #)Medicaid
WI33388200(PERFORMING)Medicaid
WIT61819Medicare UPIN
WI38365100 (BILLING #)Medicaid