MEDICARE: FALLS DENTAL, S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1083994834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FALLS DENTAL, S.C.

Provider Business Mailing Address
First Line	:	200 MONROE ST
Second Line	:
City	:	SHEBOYGAN FALLS
State	:	WI
Zip	:	53085-1428
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MONROE ST
Second Line	:
City	:	SHEBOYGAN FALLS
State	:	WI
Zip	:	53085-1428
Country	:	US
Telephone Number	:	920-467-4646
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	SANDRA PIEFER-TOMCZAK
Credential	:
Telephone Number	:	920-467-4646

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	08/25/2011

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