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General NPI Number Information
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NPI Number | 1437219417
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Entity Type | Organization
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Legal Business Name | DENTISTRY OF WISCONSIN
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1260 W MAIN ST SUITE 1
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-1930
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Country | US
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Telephone | 608-834-8668
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Fax |
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Provider Business Mailing Address
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Address Line | 1260 W MAIN ST SUITE 1
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-1930
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Country | US
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Telephone | 608-834-8668
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES AMSTADT
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Credential | DDS
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Telephone | 608-834-6321
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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 | 2433
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License Number State | WI
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