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General NPI Number Information
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NPI Number | 1467919985
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Entity Type | Organization
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Legal Business Name | ALL FAMILY DENTAL CHIPPEWA FALLS LLC
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Dates
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Enumeration Date | 02/21/2019
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 425 W PRAIRIE VIEW RD
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-3389
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Country | US
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Telephone | 715-726-1060
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Fax |
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Provider Business Mailing Address
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Address Line | 425 W PRAIRIE VIEW RD
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-3389
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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 | CONTROLLER
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Name | OLGA GRENOVA
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Credential |
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Telephone | 608-833-2213
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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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