MEDICARE: CHRISTMAN FAMILY DENTAL SC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1902344989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTMAN FAMILY DENTAL SC

Provider Business Mailing Address
First Line	:	PO BOX 25
Second Line	:	112 S. STONE STREET
City	:	AUGUSTA
State	:	WI
Zip	:	54722
Country	:	US
Telephone Number	:	715-286-2960
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 S STONE ST
Second Line	:
City	:	AUGUSTA
State	:	WI
Zip	:	54722-7221
Country	:	US
Telephone Number	:	715-286-2960
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. JULIE PAULSON
Credential	:
Telephone Number	:	715-286-2960

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	02/09/2017

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Directions to “CHRISTMAN FAMILY DENTAL SC ” Practice Location

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