Healthcare Provider Details

I. General information

NPI: 1437552940
Provider Name (Legal Business Name): GREENBRANCH DENTAL L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GRANITE ST
HURLEY WI
54534-1372
US

IV. Provider business mailing address

PO BOX 146
MERCER WI
54547-0146
US

V. Phone/Fax

Practice location:
  • Phone: 715-561-2386
  • Fax: 715-561-2011
Mailing address:
  • Phone: 715-476-3432
  • Fax: 715-476-3418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2279
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6052
License Number StateWI

VIII. Authorized Official

Name: DR. JEFFREY MICHAEL NEHRING
Title or Position: CO-OWNER AND PRESIDENT
Credential: D.D.S
Phone: 715-476-3432