Lodi Valley Gentle Dental LLP
Clinic/Center, Dental in Lodi, WI. Organization (NPI-2).
NPI number1861694929
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1861694929
- Entity type
- Organization (NPI-2)
- Legal business name
- Lodi Valley Gentle Dental LLP
- Organization subpart
- No
- Enumeration date
- Jun 1, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | 5001592 | WI | Yes |
Practice location
216 S Main StLodi, WI 53555-1121
Phone 608-592-4398 · Fax 608-592-5245
Mailing address
216 S Main StLodi, WI 53555-1121
Phone 608-592-4398 · Fax 608-592-5245
Authorized official
Gene Richard Sorensen
Partnerchip Co-Owner
6085924398
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