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General NPI Number Information
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NPI Number | 1841845674
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Entity Type | Organization
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Legal Business Name | MDC OSHKOSH II, L.L.C.
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 08/08/2019
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Provider Practice Location Address
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Address Line | 1795 W POINTE DR
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City | OSHKOSH
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State | WI
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Zip | 54902-4297
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Country | US
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Telephone | 920-235-6453
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1658
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City | FOND DU LAC
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State | WI
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Zip | 54936-1658
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Country | US
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Telephone | 920-579-3188
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. BERNARD JOSEPH BOLKA IV
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Credential | CPA
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Telephone | 920-579-3188
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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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