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General NPI Number Information
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NPI Number | 1730339367
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTAL CENTER S.C.
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 230 N SAWYER ST
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City | OSHKOSH
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State | WI
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Zip | 54902-4280
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Country | US
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Telephone | 920-233-1030
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Fax | 920-233-7398
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Provider Business Mailing Address
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Address Line | 230 N SAWYER ST
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City | OSHKOSH
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State | WI
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Zip | 54902-4280
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Country | US
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Telephone | 920-233-1030
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Fax | 920-233-7398
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILLIP ANDREW BAKER
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Credential | D.D.S.
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Telephone | 920-233-1030
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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 | 4436-015
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License Number State | WI
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