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General NPI Number Information
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NPI Number | 1467269753
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Entity Type | Organization
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Legal Business Name | MERCY DENTAL EVANSVILLE LLC
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 109 S MADISON ST
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City | EVANSVILLE
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State | WI
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Zip | 53536-1319
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Country | US
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Telephone | 608-882-4441
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Fax |
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Provider Business Mailing Address
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Address Line | 109 S MADISON ST
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City | EVANSVILLE
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State | WI
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Zip | 53536-1319
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Country | US
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Telephone | 608-882-4441
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MARCIE RAULS
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Credential |
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Telephone | 608-438-9058
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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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