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General NPI Number Information
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NPI Number | 1952618225
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Entity Type | Organization
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Legal Business Name | D H C S C
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 10/25/2010
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Provider Practice Location Address
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Address Line | 215 5TH AVE
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City | EAU CLAIRE
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State | WI
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Zip | 54703-5698
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Country | US
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Telephone | 715-832-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 215 5TH AVE
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City | EAU CLAIRE
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State | WI
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Zip | 54703-5698
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Country | US
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Telephone | 715-832-3100
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JOHN N TESSENDORF
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Credential | DDS
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Telephone | 715-832-3100
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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 | 2245-15
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License Number State | WI
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