MEDICARE: DENTAL HEALTH CENTER, S.C.

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	1223G0001X	General Practice Dentistry	3599	WI

General Provider Information

NPI Number	:	1720055015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL HEALTH CENTER, S.C.

Provider Business Mailing Address
First Line	:	5541 US HIGHWAY 10 E
Second Line	:	SUITE A
City	:	STEVENS POINT
State	:	WI
Zip	:	54481-9117
Country	:	US
Telephone Number	:	715-344-7911
Fax Number	:	715-344-7912

Provider Business Practice Location Address
First Line	:	5541 US HIGHWAY 10 E
Second Line	:	SUITE A
City	:	STEVENS POINT
State	:	WI
Zip	:	54481-9117
Country	:	US
Telephone Number	:	715-344-7911
Fax Number	:	715-344-7912

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAUL J. KOEHL
Credential	:	D.D.S.
Telephone Number	:	715-344-7911

Provider Enumeration Date	:	03/05/2006
Last Update Date	:	08/22/2020

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