Healthcare Provider Details

I. General information

NPI: 1508384033
Provider Name (Legal Business Name): MACALL SCHMELZER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4182 W WISCONSIN AVE
APPLETON WI
54913-8652
US

IV. Provider business mailing address

1128 QUINCY ST
STURGEON BAY WI
54235-1831
US

V. Phone/Fax

Practice location:
  • Phone: 920-734-4649
  • Fax: 715-842-7331
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1002906-16
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: