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General NPI Number Information
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NPI Number | 1891172425
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Entity Type | Organization
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Legal Business Name | SUNRIDGE DENTAL LLC
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 2926 FINGER RD
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City | GREEN BAY
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State | WI
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Zip | 54311-7548
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Country | US
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Telephone | 920-468-8085
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Fax |
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Provider Business Mailing Address
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Address Line | 2926 FINGER RD
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City | GREEN BAY
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State | WI
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Zip | 54311-7548
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Country | US
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Telephone | 920-468-8085
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JILL M CARTER
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Credential | D.D.S.
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Telephone | 920-468-8085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6367
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License Number State | WI
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