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General NPI Number Information
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NPI Number | 1366772204
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Entity Type | Organization
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Legal Business Name | TRIMARK DENTAL CLINIC, LLP
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Dates
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Enumeration Date | 12/27/2009
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Last Update Date | 12/27/2009
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Provider Practice Location Address
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Address Line | 2130 KENNEDY RD
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City | JANESVILLE
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State | WI
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Zip | 53545-0887
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Country | US
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Telephone | 608-752-7452
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Fax | 608-752-4918
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Provider Business Mailing Address
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Address Line | 2130 KENNEDY RD
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City | JANESVILLE
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State | WI
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Zip | 53545-0887
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Country | US
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Telephone | 608-752-7452
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Fax | 608-752-4918
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Authorized Official
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Title or Position | DENTIST/PARTNER
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Name | DR. PATRICIA ANN LYONS
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Credential | D.D.S.
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Telephone | 608-752-7452
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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 | 0004660
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License Number State | WI
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