| Organization Name: | DOWNTOWN FAMILY DENTAL OF BARABOO |
| NPI Number: | 1164536967 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TONI M HOLLOWAY (OFFICE MANAGER) |
| Mailing Address: | 147 3rd St Baraboo |
| State: | WI US |
| Postal Code: | 539132423 |
| Phone Number: | 6083563790 |
| Fax Number: | 6083567863 |
| NPI Enumeration Date: | 08/18/2006 |
| 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: | |