| Fox River Periodontics Sc | |
|
2557b East Calumet St Appleton WI 54915 | |
| (920) 733-7770 | |
| (920) 733-7798 |
| Full Name | Fox River Periodontics Sc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 2557b East Calumet St, Appleton, Wisconsin |
| Authorized Official Name and Position | Jason William Cooke (PRESIDENT) |
| Authorized Official Contact | 9207337770 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fox River Periodontics Sc 2557b East Calumet St Appleton WI 54915 Ph: (920) 733-7770 | Fox River Periodontics Sc 2557b East Calumet St Appleton WI 54915 Ph: (920) 733-7770 |
| NPI Number | 1134339500 |
|---|---|
| Provider Enumeration Date | 05/23/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134339500 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 5864-015 (Wisconsin) | Primary |
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