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General NPI Number Information
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NPI Number | 1336568351
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Entity Type | Organization
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Legal Business Name | DAMROW DENTAL LLC
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Dates
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Enumeration Date | 04/08/2014
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Last Update Date | 04/08/2014
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Provider Practice Location Address
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Address Line | 618 S GREEN BAY RD
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City | NEENAH
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State | WI
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Zip | 54956-3273
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Country | US
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Telephone | 267-970-0572
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 WITTMANN DR
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City | MENASHA
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State | WI
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Zip | 54952-3809
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Country | US
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Telephone | 920-886-6565
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Fax | 920-886-6570
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Authorized Official
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Title or Position | MEMBER
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Name | MICHAEL DAMROW
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Credential | DDS
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Telephone | 267-970-0572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6192-15
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License Number State | WI
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