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General NPI Number Information
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NPI Number | 1396468476
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Entity Type | Organization
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Legal Business Name | FOX VALLEY DENTAL CENTER
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 760 W NORTHLAND AVE
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City | APPLETON
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State | WI
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Zip | 54914-1425
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Country | US
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Telephone | 920-731-7717
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Fax | 920-733-6014
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Provider Business Mailing Address
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Address Line | 315 KRAFT ST
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City | NEENAH
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State | WI
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Zip | 54956-4988
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Country | US
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Telephone | 415-307-6025
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. KATIE LEAH HAREID
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Credential | DDS
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Telephone | 415-307-6025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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