| Elite Smiles Dental, Ltd | |
|
315 W Wisconsin Ave Appleton WI 54911-4355 | |
| (920) 731-2211 | |
| (920) 733-7176 |
| Full Name | Elite Smiles Dental, Ltd |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 315 W Wisconsin Ave, Appleton, Wisconsin |
| Authorized Official Name and Position | Alissa Edwards (DENTIST) |
| Authorized Official Contact | 9207312211 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Smiles Dental, Ltd 315 W Wisconsin Ave Appleton WI 54911-4355 Ph: (920) 731-2211 | Elite Smiles Dental, Ltd 315 W Wisconsin Ave Appleton WI 54911-4355 Ph: (920) 731-2211 |
| NPI Number | 1154781870 |
|---|---|
| Provider Enumeration Date | 02/24/2016 |
| Last Update Date | 02/24/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154781870 | NPI | - | NPPES |
| 1578874426 | Other | WI | NPI TYPE 1 |
| 6542-15 | Other | WI | LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 6542-15 (Wisconsin) | Primary |
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