| Fennimore Dental, Llc | |
|
220 Lincoln Avenue Fennimore WI 53809 | |
| (608) 822-3770 | |
| (608) 822-7680 |
| Full Name | Fennimore Dental, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 220 Lincoln Avenue, Fennimore, Wisconsin |
| Authorized Official Name and Position | Zhenyu Liang (GENERAL DENTIST) |
| Authorized Official Contact | 6088223770 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fennimore Dental, Llc 220 Lincoln Avenue Fennimore WI 53809 Ph: (608) 822-3770 | Fennimore Dental, Llc 220 Lincoln Avenue Fennimore WI 53809 Ph: (608) 822-3770 |
| NPI Number | 1801367545 |
|---|---|
| Provider Enumeration Date | 12/06/2018 |
| Last Update Date | 12/06/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801367545 | NPI | - | NPPES |
| 03359042 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |