| Lodi Valley Gentle Dental Llp | |
|
216 S Main St Lodi WI 53555-1121 | |
| (608) 592-4398 | |
| (608) 592-5245 |
| Full Name | Lodi Valley Gentle Dental Llp |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 216 S Main St, Lodi, Wisconsin |
| Authorized Official Name and Position | Gene Richard Sorensen (PARTNERCHIP CO-OWNER) |
| Authorized Official Contact | 6085924398 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lodi Valley Gentle Dental Llp 216 S Main St Lodi WI 53555-1121 Ph: (608) 592-4398 | Lodi Valley Gentle Dental Llp 216 S Main St Lodi WI 53555-1121 Ph: (608) 592-4398 |
| NPI Number | 1861694929 |
|---|---|
| Provider Enumeration Date | 06/01/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861694929 | NPI | - | NPPES |
| 33561900 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 5001592 (Wisconsin) | Primary |