Healthcare Provider Details

I. General information

NPI: 1457934945
Provider Name (Legal Business Name): LIESEN PINZL KESSINGER DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 OAK ST
WOODRUFF WI
54568
US

IV. Provider business mailing address

PO BOX 260
WOODRUFF WI
54568-0260
US

V. Phone/Fax

Practice location:
  • Phone: 715-356-3474
  • Fax:
Mailing address:
  • Phone: 715-356-3474
  • Fax: 715-358-5145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MONICA M SCHMIDT
Title or Position: OFFICE MANAGER
Credential:
Phone: 715-762-4825