Healthcare Provider Details

I. General information

NPI: 1942379805
Provider Name (Legal Business Name): SZMANDA DENTAL CENTER, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227071 HUMMINGBIRD RD
WAUSAU WI
54401-6311
US

IV. Provider business mailing address

227071 HUMMINGBIRD RD
WAUSAU WI
54401-6311
US

V. Phone/Fax

Practice location:
  • Phone: 715-845-3200
  • Fax: 715-842-4369
Mailing address:
  • Phone: 715-845-3200
  • Fax: 715-842-4369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

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