Healthcare Provider Details

I. General information

NPI: 1194241216
Provider Name (Legal Business Name): NORTH APPLETON DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3521 COMMERCE CT
APPLETON WI
54911-8579
US

IV. Provider business mailing address

W5840 GERANIUM DR
APPLETON WI
54915-5662
US

V. Phone/Fax

Practice location:
  • Phone: 920-734-7730
  • Fax:
Mailing address:
  • Phone: 920-954-8216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA KATZENMAIER
Title or Position: OWNER
Credential: RDH
Phone: 920-734-7730