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General NPI Number Information
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NPI Number | 1336316140
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Entity Type | Organization
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Legal Business Name | RURAL DENTAL HEALTH PROJECT
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 1111 LANGLADE RD
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City | ANTIGO
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State | WI
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Zip | 54409-2738
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Country | US
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Telephone | 715-571-6554
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 LANGLADE RD
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City | ANTIGO
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State | WI
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Zip | 54409-2738
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Country | US
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Telephone | 715-571-6554
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Fax |
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Authorized Official
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Title or Position | DENTAL DIRECTOR
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Name | MS. GEORGIA A. FISCHER
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Credential |
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Telephone | 715-571-6554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number |
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License Number State | WI
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