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General NPI Number Information
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NPI Number | 1427794569
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Entity Type | Organization
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Legal Business Name | DANIEL FAMA DDS LLC
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 2805 LIBAL ST STE C
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City | GREEN BAY
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State | WI
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Zip | 54301-2888
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Country | US
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Telephone | 920-339-8980
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Fax |
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Provider Business Mailing Address
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Address Line | 3142 ANSTON RD
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City | SUAMICO
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State | WI
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Zip | 54313-8222
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DANIEL FAMA
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Credential | DDS
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Telephone | 585-705-5750
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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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