Provider Demographics
NPI:1306900451
Name:BARSTAD, DANIELLE NOEL (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:NOEL
Last Name:BARSTAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:BARSTAD
Other - Last Name:MESSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:MS 958
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-7451
Mailing Address - Fax:414-266-6238
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:DENTAL CLINIC
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-2040
Practice Address - Fax:414-266-5677
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001212-0151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1306900451Medicaid