Provider Demographics
NPI:1548836414
Name:STRUPP, CHAD RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:RICHARD
Last Name:STRUPP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 DEBBIE LN
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-9134
Mailing Address - Country:US
Mailing Address - Phone:262-305-8979
Mailing Address - Fax:
Practice Address - Street 1:410 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SLINGER
Practice Address - State:WI
Practice Address - Zip Code:53086-9650
Practice Address - Country:US
Practice Address - Phone:262-644-6951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002542-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice