Healthcare Provider Details

I. General information

NPI: 1881107746
Provider Name (Legal Business Name): ALL FAMILY DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 STEIN BLVD
EAU CLAIRE WI
54701-6978
US

IV. Provider business mailing address

3131 STEIN BLVD
EAU CLAIRE WI
54701-6978
US

V. Phone/Fax

Practice location:
  • Phone: 715-835-7172
  • Fax:
Mailing address:
  • Phone: 715-835-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: OLGA GRENOVA
Title or Position: DIRECTOR OF ACCOUNTING
Credential:
Phone: 608-833-2213