| Downtown Family Dental Of West Bend, Inc | |
|
309 N 7th Ave West Bend WI 53095-3242 | |
| (262) 338-1164 | |
| (262) 338-1646 |
| Full Name | Downtown Family Dental Of West Bend, Inc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 309 N 7th Ave, West Bend, Wisconsin |
| Authorized Official Name and Position | Lawrence T. Porter (OWNER) |
| Authorized Official Contact | 2623381164 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Downtown Family Dental Of West Bend, Inc 309 N 7th Ave West Bend WI 53095-3242 Ph: (262) 338-1164 | Downtown Family Dental Of West Bend, Inc 309 N 7th Ave West Bend WI 53095-3242 Ph: (262) 338-1164 |
| NPI Number | 1881755692 |
|---|---|
| Provider Enumeration Date | 12/13/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881755692 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 1412 (Wisconsin) | Primary |
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