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General NPI Number Information
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NPI Number | 1922665637
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Entity Type | Individual
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Provider Name | BEN LONSDORF DDS
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Gender | Male
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 9547 LAKEVIEW DRIVE #200
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City | MINOCQUA
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State | WI
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Zip | 54548
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Country | US
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Telephone | 715-356-7330
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Fax |
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Provider Business Mailing Address
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Address Line | 7845 LAKE CUNARD CAMPGROUND RD
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City | LAKE TOMAHAWK
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State | WI
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Zip | 54539-9377
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Country | US
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Telephone | 715-614-0770
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1001849-15
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License Number State | WI
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