| Baxa Dental Inc., S.c. | |
|
35791 Osseo Rd Independence WI 54747-9096 | |
| (715) 985-3316 | |
| (715) 985-2542 |
| Full Name | Baxa Dental Inc., S.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 35791 Osseo Rd, Independence, Wisconsin |
| Authorized Official Name and Position | William J. Baxa (OWNER/PRESIDENT) |
| Authorized Official Contact | 7159853316 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Baxa Dental Inc., S.c. 35791 Osseo Rd Po Box 550 Independence WI 54747-9096 Ph: (715) 985-3316 | Baxa Dental Inc., S.c. 35791 Osseo Rd Independence WI 54747-9096 Ph: (715) 985-3316 |
| NPI Number | 1457361941 |
|---|---|
| Provider Enumeration Date | 08/08/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457361941 | NPI | - | NPPES |
| 76993 | Other | WI | WPS |
| 33445800 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 0003045 (Wisconsin) | Primary |
Western Dairyland Eoc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 23140 Whitehall Rd, Independence, WI 54747 Phone: 715-985-2391 Fax: 715-985-2581 |