Healthcare Provider Details

I. General information

NPI: 1962658609
Provider Name (Legal Business Name): SZMANDA DENTAL CENTER, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S. 3RD AVE
EDGAR WI
54426-9281
US

IV. Provider business mailing address

107 S. 3RD AVE
EDGAR WI
54426-9281
US

V. Phone/Fax

Practice location:
  • Phone: 715-352-2700
  • Fax:
Mailing address:
  • Phone: 715-352-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DAVID B WELLES
Title or Position: COO
Credential:
Phone: 715-845-3200