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General NPI Number Information
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NPI Number | 1386102465
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Entity Type | Organization
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Legal Business Name | PARC VILLAGE DENTAL, LLC
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Dates
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Enumeration Date | 03/07/2019
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Last Update Date | 03/07/2019
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Provider Practice Location Address
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Address Line | 2805 LIBAL STREET, SUITE A
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City | GREEN BAY
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State | WI
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Zip | 54301
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Country | US
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Telephone | 920-336-6062
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Fax | 920-336-9272
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Provider Business Mailing Address
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Address Line | 2805 LIBAL STREET, SUITE A
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City | GREEN BAY
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State | WI
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Zip | 54301
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Country | US
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Telephone | 920-336-6062
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Fax | 920-336-9272
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Authorized Official
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Title or Position | MEMBER
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Name | STEVEN R HEIN
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Credential | DDS
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Telephone | 920-336-6062
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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 |
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License Number State |
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