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General NPI Number Information
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NPI Number | 1679127567
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Entity Type | Organization
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Legal Business Name | BARDILL DENTAL ASSOCIATES,S.C.
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 900 6TH ST N STE 200
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City | HUDSON
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State | WI
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Zip | 54016-7172
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Country | US
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Telephone | 715-386-5888
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Fax | 715-386-1648
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Provider Business Mailing Address
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Address Line | 900 6TH ST N STE 200
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City | HUDSON
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State | WI
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Zip | 54016-7172
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Country | US
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Telephone | 715-386-5888
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Fax | 715-386-1648
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MELISSA BARDILL
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Credential |
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Telephone | 715-386-8686
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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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