Healthcare Provider Details

I. General information

NPI: 1609021237
Provider Name (Legal Business Name): DR. VERONICA TOVAR D.D.S,, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W6179 NEUBERT RD
APPLETON WI
54913-7988
US

IV. Provider business mailing address

W6179 NEUBERT RD
APPLETON WI
54913-7988
US

V. Phone/Fax

Practice location:
  • Phone: 920-757-9440
  • Fax: 920-757-9390
Mailing address:
  • Phone: 920-757-9440
  • Fax: 920-757-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5365-015
License Number StateWI

VIII. Authorized Official

Name: DR. VERONICA TOVAR
Title or Position: OWNER
Credential: DDS
Phone: 920-757-9440