| Formerly Self Proprietor | |
|
310 Parker Street Boscobel WI 53805-0188 | |
| (608) 375-4640 | |
| Not Available |
| Full Name | Formerly Self Proprietor |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 310 Parker Street, Boscobel, Wisconsin |
| Authorized Official Name and Position | Michael S Mecikalski (PRESIDENT) |
| Authorized Official Contact | 6083754640 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Formerly Self Proprietor Po Box 188 310 Parker Street Boscobel WI 53805-0188 Ph: (608) 375-4640 | Formerly Self Proprietor 310 Parker Street Boscobel WI 53805-0188 Ph: (608) 375-4640 |
| NPI Number | 1386727972 |
|---|---|
| Provider Enumeration Date | 10/24/2006 |
| Last Update Date | 08/16/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386727972 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | WI3718 (Wisconsin) | Primary |
Boscobel Family Dental Care Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 105 E Bluff St, Boscobel, WI 53805 Phone: 608-375-4549 | |
L L Clark Dds Sc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 105 East Bluff Street, Boscobel, WI 53805 Phone: 608-375-4549 Fax: 608-375-4665 | |
Boscobel Family Dental, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 105 E. Bluff Street, Boscobel, WI 53805 Phone: 608-375-4549 Fax: 608-375-4665 |