| Mishicot Dental | |
|
105 N Park Ln Mishicot WI 54228-9537 | |
| (920) 755-2336 | |
| Not Available |
| Full Name | Mishicot Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 105 N Park Ln, Mishicot, Wisconsin |
| Authorized Official Name and Position | Jason Allen Thiel (PRESIDENT / DENTIST) |
| Authorized Official Contact | 9207552336 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mishicot Dental 105 N Park Ln Mishicot WI 54228-9537 Ph: (920) 755-2336 | Mishicot Dental 105 N Park Ln Mishicot WI 54228-9537 Ph: (920) 755-2336 |
| NPI Number | 1407006869 |
|---|---|
| Provider Enumeration Date | 09/23/2008 |
| Last Update Date | 09/23/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407006869 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5096-015 (Wisconsin) | Primary |