Provider Demographics
NPI:1104906593
Name:JANECZKO-KING, CHARLENE A (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:A
Last Name:JANECZKO-KING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:JANECZKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5404 ALDERSON
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476
Mailing Address - Country:US
Mailing Address - Phone:715-355-5082
Mailing Address - Fax:715-359-5862
Practice Address - Street 1:5404 ALDERSON
Practice Address - Street 2:SUITE 300
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476
Practice Address - Country:US
Practice Address - Phone:715-355-5082
Practice Address - Fax:715-359-5862
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3323015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist