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General NPI Number Information
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NPI Number | 1376626325
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Entity Type | Organization
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Legal Business Name | MEDICAL ARTS COMPLEX DENTAL CENTER, S.C.
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 704 S WEBSTER AVE
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City | GREEN BAY
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State | WI
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Zip | 54301-3528
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Country | US
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Telephone | 920-435-6894
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Fax | 920-435-7676
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Provider Business Mailing Address
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Address Line | 704 S WEBSTER AVE
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City | GREEN BAY
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State | WI
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Zip | 54301-3528
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Country | US
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Telephone | 920-435-6894
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Fax | 920-435-7676
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DR. GARY C. NOBLE
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Credential | D.D.S.
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Telephone | 920-435-6894
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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 | 4416
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License Number State | WI
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