Lodi Valley Gentle Dental Llp | |
216 S Main St Lodi WI 53555-1121 | |
(608) 592-4398 | |
(608) 592-5245 |
Full Name | Lodi Valley Gentle Dental Llp |
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Speciality | Clinic/center - Dental |
Location | 216 S Main St, Lodi, Wisconsin |
Authorized Official Name and Position | Gene Richard Sorensen (PARTNERCHIP CO-OWNER) |
Authorized Official Contact | 6085924398 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Lodi Valley Gentle Dental Llp 216 S Main St Lodi WI 53555-1121 Ph: (608) 592-4398 | Lodi Valley Gentle Dental Llp 216 S Main St Lodi WI 53555-1121 Ph: (608) 592-4398 |
NPI Number | 1861694929 |
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Provider Enumeration Date | 06/01/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1861694929 | NPI | - | NPPES |
33561900 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | 5001592 (Wisconsin) | Primary |