Provider Demographics
NPI:1194991000
Name:ENTORF, PAMELA JEAN (GDH RDH BS MEPD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:ENTORF
Suffix:
Gender:F
Credentials:GDH RDH BS MEPD
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Other - Credentials:
Mailing Address - Street 1:620 W CLAIREMONT AVE
Mailing Address - Street 2:CHIPPEWA VALLEY TECHNICAL COLLEGE DENTAL HYGIENE PROGRA
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-833-6370
Mailing Address - Fax:715-833-6447
Practice Address - Street 1:620 W CLAIREMONT AVE
Practice Address - Street 2:CHIPPEWA VALLEY TECHNICAL COLLEGE DENTAL HYGIENE PROGRA
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701
Practice Address - Country:US
Practice Address - Phone:715-833-6506
Practice Address - Fax:715-833-6447
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI3215016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist