Healthcare Provider Details

I. General information

NPI: 1144239724
Provider Name (Legal Business Name): DENTAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E PARK AVE
CHIPPEWA FALLS WI
54729-3508
US

IV. Provider business mailing address

777 E PARK AVE
CHIPPEWA FALLS WI
54729-3508
US

V. Phone/Fax

Practice location:
  • Phone: 715-723-0366
  • Fax: 715-723-4635
Mailing address:
  • Phone: 715-723-0366
  • Fax: 715-723-4635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5001705
License Number StateWI

VIII. Authorized Official

Name: DR. PATRICK MICHAEL SNYDER
Title or Position: PRESIDENT
Credential:
Phone: 715-723-0366