| Random Lake Dentistry, Inc | |
|
37 Hickory Dr Random Lake WI 53075-1675 | |
| (920) 994-4367 | |
| Not Available |
| Full Name | Random Lake Dentistry, Inc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 37 Hickory Dr, Random Lake, Wisconsin |
| Authorized Official Name and Position | Hooman Abdolisereshki (OWNER) |
| Authorized Official Contact | 9208928466 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Random Lake Dentistry, Inc 62 S Pleasant View Rd Plymouth WI 53073-4954 Ph: (920) 892-8466 | Random Lake Dentistry, Inc 37 Hickory Dr Random Lake WI 53075-1675 Ph: (920) 994-4367 |
| NPI Number | 1982421046 |
|---|---|
| Provider Enumeration Date | 09/20/2024 |
| Last Update Date | 09/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982421046 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Generations Family Dental Care-random Lake, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 37 Hickory Dr, Random Lake, WI 53075 Phone: 920-994-4367 |