| Deforest Dental Services | |
|
210 N. Main St. Ste 103 Deforest WI 53532 | |
| (608) 846-3948 | |
| (608) 846-7526 |
| Full Name | Deforest Dental Services |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 210 N. Main St., Deforest, Wisconsin |
| Authorized Official Name and Position | Gerald Roger Corcoran (PRESIDENT) |
| Authorized Official Contact | 6088463948 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Deforest Dental Services 210 N. Main St. Ste 103 Deforest WI 53532 Ph: (608) 846-3948 | Deforest Dental Services 210 N. Main St. Ste 103 Deforest WI 53532 Ph: (608) 846-3948 |
| NPI Number | 1730282344 |
|---|---|
| Provider Enumeration Date | 09/07/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730282344 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2412WI (Wisconsin) | Primary |