| Upper Lakes Dental, Llc | |
|
908 E Main St Ste C Winneconne WI 54986-9672 | |
| (920) 582-0688 | |
| Not Available |
| Full Name | Upper Lakes Dental, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 908 E Main St Ste C, Winneconne, Wisconsin |
| Authorized Official Name and Position | Ryan Gonzalez (OWNER) |
| Authorized Official Contact | 9205820688 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Upper Lakes Dental, Llc Po Box 369 Winneconne WI 54986-0369 Ph: (920) 582-0688 | Upper Lakes Dental, Llc 908 E Main St Ste C Winneconne WI 54986-9672 Ph: (920) 582-0688 |
| NPI Number | 1124580352 |
|---|---|
| Provider Enumeration Date | 04/05/2019 |
| Last Update Date | 04/05/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124580352 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Winneconne Family Dentistry Acquisition Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 902 E Main St, Winneconne, WI 54986 Phone: 920-705-1123 | |
Winneconne Family Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 902 E Main St, Winneconne, WI 54986 Phone: 920-582-4427 Fax: 920-582-7563 |