Provider Demographics
NPI:1932264132
Name:JANOVICZ, PETE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETE
Middle Name:
Last Name:JANOVICZ
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 1:6638 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-1317
Mailing Address - Country:US
Mailing Address - Phone:262-654-5815
Mailing Address - Fax:262-654-3600
Practice Address - Street 1:6638 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-1317
Practice Address - Country:US
Practice Address - Phone:262-654-5815
Practice Address - Fax:262-654-3600
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI83-0352641OtherTAX ID