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General NPI Number Information
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NPI Number | 1326573320
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Entity Type | Organization
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Legal Business Name | GELHAUS DENTAL CLINIC S.C.
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 1155 W BROADWAY AVE
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City | MEDFORD
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State | WI
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Zip | 54451-1372
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Country | US
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Telephone | 715-748-4020
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Fax | 715-748-4020
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Provider Business Mailing Address
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Address Line | 1155 W BROADWAY AVE
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City | MEDFORD
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State | WI
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Zip | 54451-1372
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Country | US
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Telephone | 715-748-4020
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Fax | 715-748-4020
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Authorized Official
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Title or Position | DENTIST
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Name | DR. FREDERICK CHARLES GELHAUS
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Credential | DDS
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Telephone | 715-748-4020
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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 | 6784
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7139
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3192
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License Number State | WI
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