| Timbercrest Dental Center, S.c. | |
|
821 E 1st Ave Suite 3 Appleton WI 54911-1501 | |
| (920) 734-9148 | |
| (920) 734-8710 |
| Full Name | Timbercrest Dental Center, S.c. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 821 E 1st Ave, Appleton, Wisconsin |
| Authorized Official Name and Position | John Berton Luther (PRESIDENT) |
| Authorized Official Contact | 9207349148 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Timbercrest Dental Center, S.c. 821 E 1st Ave Suite 3 Appleton WI 54911-1501 Ph: (920) 734-9148 | Timbercrest Dental Center, S.c. 821 E 1st Ave Suite 3 Appleton WI 54911-1501 Ph: (920) 734-9148 |
| NPI Number | 1356414114 |
|---|---|
| Provider Enumeration Date | 11/17/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356414114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 5588-015 (Wisconsin) | Primary |
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