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General NPI Number Information
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NPI Number | 1356549422
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Entity Type | Organization
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Legal Business Name | WESTERN DAIRYLAND EOC, INC.
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 23122 WHITEHALL RD
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City | INDEPENDENCE
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State | WI
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Zip | 54747-7702
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Country | US
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Telephone | 715-985-2391
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Fax | 715-985-3239
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Provider Business Mailing Address
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Address Line | 23122 WHITEHALL RD
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City | INDEPENDENCE
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State | WI
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Zip | 54747-7702
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Country | US
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Telephone | 715-985-2391
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Fax | 715-985-3239
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JAMES W SCHWARTZ
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Credential |
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Telephone | 715-985-2391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 5946016
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License Number State | WI
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