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General NPI Number Information
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NPI Number | 1962910810
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Entity Type | Organization
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Legal Business Name | RED CEDAR DENTISRY LLC
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Dates
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Enumeration Date | 01/12/2018
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Last Update Date | 01/12/2018
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Provider Practice Location Address
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Address Line | 2409 HILS CT
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City | MENOMONIE
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State | WI
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Zip | 54751-1141
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Country | US
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Telephone | 715-309-2999
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Fax | 715-309-2983
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Provider Business Mailing Address
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Address Line | 2409 HILS CT
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City | MENOMONIE
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State | WI
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Zip | 54751-1141
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Country | US
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Telephone | 715-309-2999
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Fax | 715-309-2983
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. JENNIFER HASTINGS
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Credential | DDS
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Telephone | 715-309-2999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 7263-15
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License Number State | WI
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