Provider Demographics
NPI:1588051692
Name:LOIS, JEREMY STEVEN (DDS)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:STEVEN
Last Name:LOIS
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 1:450 MILL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:WI
Mailing Address - Zip Code:53125-1242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 MILL ST STE 101
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:WI
Practice Address - Zip Code:53125-1242
Practice Address - Country:US
Practice Address - Phone:262-275-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001276-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice