Roger John Gorectke, DDS
Individual provider Active NPI General Practice Dentistry · Woodruff, WI
NPI 1194928036 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1194928036
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 3796015 (WI)
- Practice address
- 110 Maple Street
Woodruff, WI 54568-1130 - Phone
- (815) 356-6339
- Fax
- (715) 356-6355
- NPI assigned
- Jun 7, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3796015 | WI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwoods Dentistry Woodruff LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3796015 | WI | Yes |
Addresses
Primary practice location
110 Maple Street
Woodruff, WI 54568-1130
Mailing address
PO Box 1130
Woodruff, WI 54568-1130
Phone (715) 356-6339
Other providers in Woodruff, WI
- Zachary D. Furtak
- Kyle Micheal Gamoke
- Michel P Gelinas
- Gonzalez Family Chiropractic LLC.
- Guillermo Eduardo Gonzalez
- Mark W Grady
- Whitney Lynn Graham
- Lonna L Grosskopf
- Ronald S Hagen
- James A. Halminiak
All providers in Woodruff, WI · General Practice Dentistry in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.