| Poth Family Dental, S.c. | |
|
100 Martin Dr Fredonia WI 53021-9455 | |
| (262) 692-2461 | |
| (262) 692-9889 |
| Full Name | Poth Family Dental, S.c. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 100 Martin Dr, Fredonia, Wisconsin |
| Authorized Official Name and Position | John Everett Poth (PRESIDENT) |
| Authorized Official Contact | 2626922461 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Poth Family Dental, S.c. 100 Martin Dr Fredonia WI 53021-9455 Ph: (262) 692-2461 | Poth Family Dental, S.c. 100 Martin Dr Fredonia WI 53021-9455 Ph: (262) 692-2461 |
| NPI Number | 1376747493 |
|---|---|
| Provider Enumeration Date | 06/13/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376747493 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 4245-015 (Wisconsin) | Primary |