Advanced Dental Care Clinic Sc
Clinic/Center, Dental in Plymouth, WI. Organization (NPI-2).
NPI number1396258752
StatusActive
Last updated in NPPESDec 13, 2019
Details
- NPI
- 1396258752
- Entity type
- Organization (NPI-2)
- Legal business name
- Advanced Dental Care Clinic Sc
- Organization subpart
- No
- Enumeration date
- Nov 8, 2017
- Certification date
- Dec 13, 2019
- Last updated
- Dec 13, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
62 S Pleasant View RoadPlymouth, WI 53073
Phone 920-892-8466
Mailing address
62 S Pleasant View RdPlymouth, WI 53073-4954
Authorized official
Hooman Sereshki
Owner
9208928466
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