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General NPI Number Information
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NPI Number | 1952460123
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Entity Type | Organization
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Legal Business Name | REEDSBURG FAMILY DENTAL, S.C.
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 764 CRESTVIEW DR
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City | REEDSBURG
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State | WI
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Zip | 53959-2581
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Country | US
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Telephone | 608-524-4213
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Fax | 608-524-0743
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Provider Business Mailing Address
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Address Line | 764 CRESTVIEW DR P.O. BOX 383
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City | REEDSBURG
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State | WI
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Zip | 53959-2581
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Country | US
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Telephone | 608-524-4213
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Fax | 608-524-0743
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ASHLEY E SORENSON
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Credential | D.D.S.
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Telephone | 608-524-4213
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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 | 3386-015
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License Number State | WI
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