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General NPI Number Information
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NPI Number | 1457244451
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Entity Type | Organization
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Legal Business Name | NEW HOLSTEIN FAMILY DENTAL
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 1250 TECKLA PL
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City | KIEL
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State | WI
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Zip | 53042-9623
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Country | US
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Telephone | 920-898-4110
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 TECKLA PL
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City | KIEL
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State | WI
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Zip | 53042-9623
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Country | US
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Telephone | 920-898-4110
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | CONSTANCE WALLANDER
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Credential | DMD
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Telephone | 920-894-2305
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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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