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General NPI Number Information
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NPI Number | 1609009661
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Entity Type | Individual
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Provider Name | ANNA FEDAK BOTTS D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 09/09/2009
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Provider Practice Location Address
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Address Line | 449 S 1ST ST
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City | EVANSVILLE
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State | WI
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Zip | 53536-1394
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Country | US
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Telephone | 608-882-4338
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Fax | 608-882-6777
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Provider Business Mailing Address
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Address Line | 449 S 1ST ST
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City | EVANSVILLE
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State | WI
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Zip | 53536-1394
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Country | US
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Telephone | 608-882-4338
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Fax | 608-882-6777
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6443
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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 | 18830
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License Number State | FL
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