Provider Demographics
NPI:1467329425
Name:WAVRUNEK, BETH M (BS, RDH)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:M
Last Name:WAVRUNEK
Suffix:
Gender:F
Credentials:BS, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-1306
Mailing Address - Country:US
Mailing Address - Phone:920-965-0831
Mailing Address - Fax:
Practice Address - Street 1:1245 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-1306
Practice Address - Country:US
Practice Address - Phone:920-965-0831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6113-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist