| Generations Family Dental Care-random Lake, Llc | |
|
37 Hickory Dr Random Lake WI 53075-1675 | |
| (920) 994-4367 | |
| Not Available |
| Full Name | Generations Family Dental Care-random Lake, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 37 Hickory Dr, Random Lake, Wisconsin |
| Authorized Official Name and Position | Fred Lacourt (MANAGER) |
| Authorized Official Contact | 4142582117 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Generations Family Dental Care-random Lake, Llc 2505 N Mayfair Rd Suite 103 Wauwatosa WI 53226-1404 Ph: (414) 258-2117 | Generations Family Dental Care-random Lake, Llc 37 Hickory Dr Random Lake WI 53075-1675 Ph: (920) 994-4367 |
| NPI Number | 1407387483 |
|---|---|
| Provider Enumeration Date | 03/22/2017 |
| Last Update Date | 03/22/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407387483 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
Random Lake Dentistry, Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 37 Hickory Dr, Random Lake, WI 53075 Phone: 920-994-4367 |