IndividualActive
Dale Willoughby, DDS
NPI 1700880556 · Oral and Maxillofacial Surgery (Dentist) · Kenosha, WI
Provider details
- NPI number
- 1700880556
- Entity type
- Individual
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- Yes
- License
- 4998-015 (WI)
Specialties & taxonomies
Dental Providers
Practice location
6707 39th Ave
Kenosha, WI 53142-7125
Phone: (262) 658-3559
Fax: (262) 658-0276
Approximate (ZIP-level) locationGet directions
Mailing address
6707 39th Ave
Kenosha, WI 53142-7125
Registry dates
- Enumerated
- 2005-06-09
- Last updated
- 2022-06-02
- Certified
- 2022-06-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.