Kent Botsford

NPI 1417041005 · on the registry since 2006 · sole proprietor

Practice

Address: 525 East Division Street
Fond Du Lac, WI 54935
Phone: (920) 921-2860
Fax: (920) 921-4228
Organisation at this address: Agnesian Healthcare Inc
Associated Periodontics
Actra Rehabilitation Associates Inc
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 3

Registry record

Primary taxonomy: 1223G0001X
1223G0001X
Licence states on file: WI
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2007-07-08

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Wisconsin