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General NPI Number Information
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NPI Number | 1841696127
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Entity Type | Organization
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Legal Business Name | EAU CLAIRE FAMILY DENTAL
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Dates
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Enumeration Date | 11/13/2014
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Last Update Date | 11/13/2014
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Provider Practice Location Address
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Address Line | 1018 REGIS CT
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City | EAU CLAIRE
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State | WI
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Zip | 54701-4404
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Country | US
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Telephone | 715-832-8063
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Fax | 715-835-1231
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Provider Business Mailing Address
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Address Line | 1018 REGIS CT
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City | EAU CLAIRE
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State | WI
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Zip | 54701-4404
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Country | US
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Telephone | 715-832-8063
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Fax | 715-835-1231
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. NATHAN HENRY FLEMING
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Credential | DDS
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Telephone | 715-832-8063
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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 | 2965
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License Number State | WI
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