Healthcare Provider Details

I. General information

NPI: 1346643525
Provider Name (Legal Business Name): ANGELA M POMERING RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E. FOUNTAIN ST.
DODGEVILLE WI
53533-1749
US

IV. Provider business mailing address

2901 W BELTLINE HWY SUITE 120
MADISON WI
53713-4226
US

V. Phone/Fax

Practice location:
  • Phone: 608-935-5550
  • Fax: 608-935-5168
Mailing address:
  • Phone: 608-443-5500
  • Fax: 608-441-2385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number5366-16
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: