| Fountain City Family Dentistry | |
|
34 N Main St Fountain City WI 54629-8705 | |
| (608) 687-3571 | |
| Not Available |
| Full Name | Fountain City Family Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 34 N Main St, Fountain City, Wisconsin |
| Authorized Official Name and Position | Desiree M. Mork (OWNER) |
| Authorized Official Contact | 6086873571 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fountain City Family Dentistry 34 N Main St Po Box 367 Fountain City WI 54629-8705 Ph: (608) 687-3571 | Fountain City Family Dentistry 34 N Main St Fountain City WI 54629-8705 Ph: (608) 687-3571 |
| NPI Number | 1457507329 |
|---|---|
| Provider Enumeration Date | 08/12/2008 |
| Last Update Date | 08/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457507329 | NPI | - | NPPES |
| 33814900 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 5882015 (Wisconsin) | Primary |