Healthcare Provider Details

I. General information

NPI: 1003422304
Provider Name (Legal Business Name): APPLETON WESTHILL DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 N WESTHILL BLVD
APPLETON WI
54914-5788
US

IV. Provider business mailing address

828 N WESTHILL BLVD
APPLETON WI
54914-5788
US

V. Phone/Fax

Practice location:
  • Phone: 920-733-2445
  • Fax:
Mailing address:
  • Phone: 920-733-2445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MITCHELL WEILAND
Title or Position: SENIOR ACCOUNTANT
Credential:
Phone: 608-343-0818