| Dental Haven For Children Sc | |
|
2612 E Calumet St Appleton WI 54915-4104 | |
| (920) 739-6808 | |
| (888) 492-5007 |
| Full Name | Dental Haven For Children Sc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2612 E Calumet St, Appleton, Wisconsin |
| Authorized Official Name and Position | Gonzalo E Hernandez (PRESIDENT) |
| Authorized Official Contact | 9207396808 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Haven For Children Sc 2612 E Calumet St Appleton WI 54915-4104 Ph: (920) 739-6808 | Dental Haven For Children Sc 2612 E Calumet St Appleton WI 54915-4104 Ph: (920) 739-6808 |
| NPI Number | 1598105637 |
|---|---|
| Provider Enumeration Date | 07/03/2013 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598105637 | NPI | - | NPPES |
| 33718600 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 4564-015 (Wisconsin) | Primary |
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