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General NPI Number Information
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NPI Number | 1861628133
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY DENTISTRY, S.C.
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Dates
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Enumeration Date | 06/01/2009
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 123 HOSPITAL DR SUITE 201
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City | WATERTOWN
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State | WI
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Zip | 53098-3331
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Country | US
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Telephone | 920-261-0588
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Fax | 920-261-0640
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Provider Business Mailing Address
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Address Line | 123 HOSPITAL DR SUITE 201
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City | WATERTOWN
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State | WI
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Zip | 53098-3331
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Country | US
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Telephone | 920-261-0588
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Fax | 920-261-0640
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Authorized Official
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Title or Position | FINANCIAL COORDINATOR
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Name | KAREN SHERRY
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Credential |
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Telephone | 920-261-0588
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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 |
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License Number State |
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