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General NPI Number Information
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NPI Number | 1386850790
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Entity Type | Organization
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Legal Business Name | G.D. PIONEK,D.D.S.,S.C.
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1825 S WEBSTER AVE SUITE 201
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City | GREEN BAY
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State | WI
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Zip | 54301-2280
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Country | US
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Telephone | 192-043-7811
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Fax |
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Provider Business Mailing Address
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Address Line | 1825 S WEBSTER AVE SUITE 201
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City | GREEN BAY
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State | WI
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Zip | 54301-2280
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Country | US
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Telephone | 192-043-7811
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. GERALD DAVID PIONEK
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Credential | D.D.S.
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Telephone | 19204378116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State | WI
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