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General NPI Number Information
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NPI Number | 1679606537
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Entity Type | Organization
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Legal Business Name | MID-TOWNE DENTAL ASSOCIATES, S.C.
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1730 7TH ST S
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-5238
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Country | US
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Telephone | 715-423-3322
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Fax | 715-424-3786
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Provider Business Mailing Address
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Address Line | 1730 7TH ST S P.O. BOX 1178
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-5238
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Country | US
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Telephone | 715-423-3322
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Fax | 715-424-3786
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT E MCGRATH
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Credential | D.D.S.
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Telephone | 715-423-3322
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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 | 5001043
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License Number State | WI
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