Healthcare Provider Details

I. General information

NPI: 1073794582
Provider Name (Legal Business Name): HOWE DENTAL ROOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 S MONROE AVE
GREEN BAY WI
54301-4018
US

IV. Provider business mailing address

526 S MONROE AVE
GREEN BAY WI
54301-4018
US

V. Phone/Fax

Practice location:
  • Phone: 920-448-7340
  • Fax:
Mailing address:
  • Phone: 920-448-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2268
License Number StateWI

VIII. Authorized Official

Name: CARRIE STEMPSKI
Title or Position: DIRECTOR
Credential: RDH
Phone: 920-448-7340