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General NPI Number Information
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NPI Number | 1154837433
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Entity Type | Organization
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Legal Business Name | WISCONSIN DENTAL HEALTH, LLC
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 12/21/2017
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Provider Practice Location Address
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Address Line | 390 S. GRAND AVE SUITE#110
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City | SUN PRAIRIE
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State | WI
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Zip | 53590
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Country | US
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Telephone | 608-237-1920
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Fax |
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Provider Business Mailing Address
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Address Line | 390 S. GRAND AVE SUITE#110
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City | SUN PRAIRIE
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State | WI
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Zip | 53590
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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 | OWNER
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Name | VIVIENNE ZHANG
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Credential | DDS
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Telephone | 608-237-1920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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