Provider Demographics
NPI:1699704288
Name:LENARDUZZI, CHARLES GIRARD (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GIRARD
Last Name:LENARDUZZI
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:W238N3214 HIGH MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-5701
Mailing Address - Country:US
Mailing Address - Phone:262-691-3316
Mailing Address - Fax:
Practice Address - Street 1:205 E WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4207
Practice Address - Country:US
Practice Address - Phone:414-778-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5002063-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33371100Medicaid