Fondy Family Dental
Clinic/Center, Dental in Fond Du Lac, WI. Organization (NPI-2).
NPI number1962099101
StatusActive
Last updated in NPPESDec 24, 2020
Details
- NPI
- 1962099101
- Entity type
- Organization (NPI-2)
- Legal business name
- Fondy Family Dental
- Organization subpart
- No
- Enumeration date
- Dec 22, 2020
- Certification date
- Dec 24, 2020
- Last updated
- Dec 24, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
35 W Scott StFond Du Lac, WI 54935-2342
Phone 920-922-2930
Mailing address
35 W Scott StFond Du Lac, WI 54935-2342
Phone 920-922-2930
Authorized official
Chad Goeke
Owner/Dentist
8155419561
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