| Mi Dentista Llc | |
|
4801 Cottage Grove Rd Ste D Madison WI 53716-1349 | |
| (608) 658-4600 | |
| Not Available |
| Full Name | Mi Dentista Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4801 Cottage Grove Rd Ste D, Madison, Wisconsin |
| Authorized Official Name and Position | Matthew Kutz (OWNER) |
| Authorized Official Contact | 6086584600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mi Dentista Llc 4801 Cottage Grove Rd Ste D Madison WI 53716-1349 Ph: (608) 658-4600 | Mi Dentista Llc 4801 Cottage Grove Rd Ste D Madison WI 53716-1349 Ph: (608) 658-4600 |
| NPI Number | 1891192415 |
|---|---|
| Provider Enumeration Date | 11/25/2014 |
| Last Update Date | 11/25/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891192415 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5729-015 (Wisconsin) | Primary |
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