MEDICARE: DANE DENTAL 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1760112247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANE DENTAL LLC

Provider Business Mailing Address
First Line	:	3066 SHADYSIDE DR
Second Line	:
City	:	STOUGHTON
State	:	WI
Zip	:	53589-3244
Country	:	US
Telephone Number	:	715-456-5148
Fax Number	:

Provider Business Practice Location Address
First Line	:	4705 DALE CURTIN DR
Second Line	:
City	:	MCFARLAND
State	:	WI
Zip	:	53558-8958
Country	:	US
Telephone Number	:	608-838-7474
Fax Number	:

Authorized Official
Title or Position	:	DENTIST, OWNER
Name	:	DR. JAIME LYN SPAULDING
Credential	:	DDS
Telephone Number	:	715-456-5148

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	06/16/2022

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