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General NPI Number Information
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NPI Number | 1821264300
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Entity Type | Organization
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Legal Business Name | MONONA RIVERPLACE DENTAL, LLC
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Dates
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Enumeration Date | 05/05/2008
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 604 RIVER PL
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City | MONONA
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State | WI
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Zip | 53716-4034
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Country | US
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Telephone | 608-222-9142
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Fax | 608-226-8818
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Provider Business Mailing Address
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Address Line | 604 RIVER PL
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City | MONONA
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State | WI
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Zip | 53716-4034
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Country | US
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Telephone | 608-222-9142
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Fax | 608-226-8818
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CRAIG A. ASWEGAN
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Credential | DDS
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Telephone | 608-222-9142
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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 | 973G
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License Number State | WI
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