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General NPI Number Information
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NPI Number | 1205360930
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Entity Type | Organization
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Legal Business Name | RASMUSSEN DENTAL LLC
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 9792 HWY 70
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City | MINOCQUA
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State | WI
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Zip | 54548-8747
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Country | US
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Telephone | 715-358-9994
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Fax | 715-358-9997
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Provider Business Mailing Address
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Address Line | 9792 HWY 70
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City | MINOCQUA
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State | WI
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Zip | 54548-8747
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Country | US
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Telephone | 715-358-9994
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Fax | 715-358-9997
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELANIE RASMUSSEN
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Credential | D.D.S.
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Telephone | 715-358-9994
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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 | 1001076-15
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License Number State | WI
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