Organization Name: | VILLAGE FAMILY DENTAL ASSOCIATES |
NPI Number: | 1073592879 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL F PEEPLES (PRESIDENT OF CORPORATION) |
Mailing Address: | 240 W. Jefferson Street Spring Green |
State: | WI US |
Postal Code: | 53588 |
Phone Number: | 6085882122 |
Fax Number: | 6085889152 |
NPI Enumeration Date: | 01/11/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |