| Rice Lake Dental Center | |
|
1501 W Stout St Rice Lake WI 54868-5001 | |
| (715) 236-8900 | |
| Not Available |
| Full Name | Rice Lake Dental Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1501 W Stout St, Rice Lake, 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 |
|---|---|
| Rice Lake Dental Center 1307 N Saint Joseph Ave Marshfield WI 54449-1340 Ph: () - | Rice Lake Dental Center 1501 W Stout St Rice Lake WI 54868-5001 Ph: (715) 236-8900 |
| NPI Number | 1992497135 |
|---|---|
| Provider Enumeration Date | 05/25/2023 |
| Last Update Date | 07/13/2023 |
| Medicare PECOS PAC ID | 2466540877 |
|---|---|
| Medicare Enrollment ID | O20230719002857 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992497135 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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