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General NPI Number Information
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NPI Number | 1538434154
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Entity Type | Organization
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Legal Business Name | VERONA FAMILY DENTAL LLC
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 06/24/2014
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Provider Practice Location Address
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Address Line | 109 E VERONA AVE
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City | VERONA
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State | WI
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Zip | 53593-1218
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Country | US
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Telephone | 608-845-6612
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Fax |
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Provider Business Mailing Address
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Address Line | 271 S MAIN ST
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City | VERONA
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State | WI
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Zip | 53593-1470
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Country | US
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Telephone | 608-845-6612
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | GENEVIEVE POPPE
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Credential |
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Telephone | 608-358-3370
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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 | 3838-15
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7275-15
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License Number State | WI
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