| Organization Name: | OAK PARK DENTAL CLINIC |
| NPI Number: | 1285760751 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JON E CRUZ (MEMBER) |
| Mailing Address: | 24164 Highway 35-70 Siren |
| State: | WI US |
| Postal Code: | 54872 |
| Phone Number: | 7153492297 |
| Fax Number: | 7153492298 |
| NPI Enumeration Date: | 02/26/2007 |
| NPI Last Update Date: | 03/09/2011 |
| 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: | |