MEDICARE: NEW RICHMOND KIDDS PEDIATRIC DENTISTRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1508478454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW RICHMOND KIDDS PEDIATRIC DENTISTRY LLC

Provider Business Mailing Address
First Line	:	1244 N 4TH ST STE 300
Second Line	:
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-7540
Country	:	US
Telephone Number	:	715-248-2246
Fax Number	:

Provider Business Practice Location Address
First Line	:	1244 N 4TH ST STE 300
Second Line	:
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-7540
Country	:	US
Telephone Number	:	715-248-2246
Fax Number	:

Authorized Official
Title or Position	:	DDS
Name	:	DR. DARCY RINDELAUB
Credential	:	DDS
Telephone Number	:	651-324-4270

Provider Enumeration Date	:	08/21/2020
Last Update Date	:	08/21/2020

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