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Dale Wayne Willoughby, DDS
Oral and Maxillofacial Surgery (Dentist) in Kenosha, Wisconsin
NPI 1700880556

Dale Wayne Willoughby is a Oral and Maxillofacial Surgery (Dentist) based in Kenosha, WI and is specialized in Oral and Maxillofacial Surgery. Dale Wayne Willoughby practices in Kenosha, WI and has the professional credentials of DDS. The NPI Number for Dale Wayne Willoughby is 1700880556 and holds a License No. 4998-015 (Wisconsin).

The current practice location address for Dale Wayne Willoughby is 6707 39Th Ave, Kenosha, WI and can be reached out via phone at 262-658-3559 and via fax at 262-658-0276.

Location: 6707 39Th Ave, Kenosha, WI, 53142-7125
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1700880556
Provider Name
Dale Wayne Willoughby
Credential
DDS
Provider Entity Type
Individual
Gender
Male
Address
6707 39Th Ave, Kenosha, WI, 53142-7125
Phone Number
262-658-3559
Fax Number
262-658-0276
Provider Enumeration Date
06/09/2005
Last Update Date
03/08/2024
institution
Provider Business Practice Location Address Details
Address
6707 39Th Ave
City
Kenosha
State
Wisconsin
Zip
53142-7125
Phone Number
262-658-3559
Fax Number
262-658-0276
person
Provider Business Mailing Address Details
Address
6707 39Th Ave
City
Kenosha
State
Wisconsin
Zip
53142-7125
Phone Number
262-658-3559
Fax Number
262-658-0276
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Oral and Maxillofacial Surgery
Taxonomy
1223S0112X
License No.
4998-015 (Wisconsin)
Definition
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
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