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NPI Code Detail

MEDICARE: VILLAGE FAMILY DENTAL ASSOCS.

MEDICARE: VILLAGE FAMILY DENTAL ASSOCS.
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1407831209
Entity Type Code : Organization
Provider Name (Legal Business Name) : VILLAGE FAMILY DENTAL ASSOCS.
Provider Business Mailing Address
First Line : 1250 PRAIRIE ST
Second Line : P.O. BOX 39
City : PRAIRIE DU SAC
State : WI
Zip : 53578-2041
Country : US
Telephone Number : 608-643-8505
Fax Number : 608-643-8097
Provider Business Practice Location Address
First Line : 1250 PRAIRIE ST
Second Line :
City : PRAIRIE DU SAC
State : WI
Zip : 53578-2041
Country : US
Telephone Number : 608-643-8505
Fax Number : 608-643-8097
Authorized Official
Title or Position : PRESIDENT OF CORPORATION
Name : MICHAEL F PEEPLES
Credential : D.D.S.
Telephone Number : 608-643-8505
Provider Enumeration Date : 12/14/2005
Last Update Date : 08/22/2020

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Directions to “VILLAGE FAMILY DENTAL ASSOCS. ” Practice Location

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