| Antigo Dental Clinic L.l.c. | |
|
707 6th Ave Antigo WI 54409 | |
| (715) 627-4391 | |
| (715) 627-4392 |
| Full Name | Antigo Dental Clinic L.l.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 707 6th Ave, Antigo, Wisconsin |
| Authorized Official Name and Position | Meghan K O'brien (PRACTICE OWNER) |
| Authorized Official Contact | 7156274391 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Antigo Dental Clinic L.l.c. 707 6th Ave Antigo WI 54409 Ph: (715) 627-4391 | Antigo Dental Clinic L.l.c. 707 6th Ave Antigo WI 54409 Ph: (715) 627-4391 |
| NPI Number | 1417004177 |
|---|---|
| Provider Enumeration Date | 01/04/2007 |
| Last Update Date | 12/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417004177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5001261-015 (Wisconsin) | Primary |
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