| The Grove Family Dental And Tmj Clinic, Llc | |
|
109 S Madison St Evansville WI 53536-1319 | |
| (608) 882-4441 | |
| Not Available |
| Full Name | The Grove Family Dental And Tmj Clinic, Llc |
|---|---|
| Speciality | Dentist |
| Location | 109 S Madison St, Evansville, Wisconsin |
| Authorized Official Name and Position | John Charles Gernetzke (MEMBER) |
| Authorized Official Contact | 6088824441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Grove Family Dental And Tmj Clinic, Llc 109 S Madison St Evansville WI 53536-1319 Ph: (608) 882-4441 | The Grove Family Dental And Tmj Clinic, Llc 109 S Madison St Evansville WI 53536-1319 Ph: (608) 882-4441 |
| NPI Number | 1295933430 |
|---|---|
| Provider Enumeration Date | 07/10/2007 |
| Last Update Date | 07/10/2007 |
| Medicare PECOS PAC ID | 5395830186 |
|---|---|
| Medicare Enrollment ID | O20071009000677 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295933430 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 4078 (Wisconsin) | Primary |
| Provider Name | John C Gernetzke |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1629050026 PECOS PAC ID: 2163517566 Enrollment ID: I20071001000188 |
Mercy Dental Evansville Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 S Madison St, Evansville, WI 53536 Phone: 608-882-4441 |