Black River Falls Dental Center | |
N6571 Lumberjack Guy Rd Black River Falls WI 54615-5405 | |
(715) 670-0400 | |
Not Available |
Full Name | Black River Falls Dental Center |
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Speciality | Clinic/Center |
Location | N6571 Lumberjack Guy Rd, Black River Falls, Wisconsin |
Authorized Official Name and Position | Kymberli Darracott (CREDENTIALING SPECIALIST) |
Authorized Official Contact | 2626545555 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Black River Falls Dental Center 1307 N Saint Joseph Ave Marshfield WI 54449-1340 Ph: () - | Black River Falls Dental Center N6571 Lumberjack Guy Rd Black River Falls WI 54615-5405 Ph: (715) 670-0400 |
NPI Number | 1285325811 |
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Provider Enumeration Date | 05/16/2023 |
Last Update Date | 07/13/2023 |
Medicare PECOS PAC ID | 2466540877 |
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Medicare Enrollment ID | O20240416000770 |
Identifier | Type | State | Issuer |
---|---|---|---|
1285325811 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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