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General NPI Number Information
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NPI Number | 1134898786
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Entity Type | Organization
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Legal Business Name | DELTA DENTAL OF WISCONSIN FOUNDATION INC
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 941 MICHIGAN AVE
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City | STEVENS POINT
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State | WI
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Zip | 54481
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Country | US
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Telephone | 715-204-1180
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Fax | 715-204-3901
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Provider Business Mailing Address
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Address Line | PO BOX 828
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City | STEVENS POINT
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State | WI
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Zip | 54481-0828
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ANN BOSON
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Credential |
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Telephone | 715-343-7209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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