Dr. Kelly Gruetzmacher Groskopf, D.D.S.
Dentist, General Practice in Oconomowoc, WI. Individual provider (NPI-1).
NPI number1962850701
StatusActive
Last updated in NPPESMar 3, 2017
Details
- NPI
- 1962850701
- Entity type
- Individual (NPI-1)
- Name
- Dr. Kelly Gruetzmacher Groskopf
- Credential
- D.D.S.
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jun 2, 2016
- Last updated
- Mar 3, 2017
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 1001308-15 | WI | Yes |
Other names
- Kelly Marie Gruetzmacher (Former Name)
Practice location
W381n8165 Rolling River CirOconomowoc, WI 53066-8950
Phone 715-459-3222
Mailing address
1951 Commerce PkwyFort Atkinson, WI 53538-3139
Phone 920-563-4415
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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