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Upper Lakes Dental, LLC

Clinic/Center, Dental in Winneconne, WI. Organization (NPI-2).

NPI number1124580352
StatusActive
Last updated in NPPESApr 5, 2019

Details

NPI
1124580352
Entity type
Organization (NPI-2)
Legal business name
Upper Lakes Dental, LLC
Organization subpart
No
Enumeration date
Apr 5, 2019
Last updated
Apr 5, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QD0000X Clinic/Center, Dental––Yes

Practice location

908 E Main St Ste C
Winneconne, WI 54986-9672

Phone 920-582-0688

Mailing address

Po Box 369
Winneconne, WI 54986-0369

Phone 920-582-0688

Authorized official

Ryan Gonzalez
Owner
9205820688

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

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