Basic Information
| Provider Information | |||||||||
| NPI: | 1518691179 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUDRONOWICZ | ||||||||
| FirstName: | ELYSE | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | RDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2901 W BELTLINE HWY STE 120 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537134231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084435500 | ||||||||
| FaxNumber: | 6084412385 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 E FOUNTAIN ST | ||||||||
| Address2: | |||||||||
| City: | DODGEVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535331749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6089355550 | ||||||||
| FaxNumber: | 6089355168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2022 | ||||||||
| LastUpdateDate: | 07/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 7001015-16 | WI | Y | Dental Providers | Dental Hygienist |
No ID Information.