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General NPI Number Information
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NPI Number | 1669128260
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Entity Type | Organization
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Legal Business Name | SHAWANO FAMILY DENTISTRY
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 115 ALPINE CT
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City | SHAWANO
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State | WI
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Zip | 54166-2048
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Country | US
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Telephone | 715-524-4935
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Fax |
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Provider Business Mailing Address
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Address Line | 115 ALPINE CT
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City | SHAWANO
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State | WI
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Zip | 54166-2048
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Country | US
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Telephone | 715-524-4935
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. REBECCA MARIE STEVENS
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Credential | D.D.S
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Telephone | 262-865-7293
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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 |
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License Number State |
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