Delavan Family Dental

Organization Active NPI General Practice Dentistry · Delavan, WI

NPI 1922490655 · NPPES record last updated Mar 4, 2015

Key facts

NPI
1922490655
Entity type
Organization (NPI type 2)
Primary specialty
General Practice Dentistry 1223G0001X
Legal business name
DELAVAN FAMILY DENTAL
Practice address
614 E Walworth Ave
Delavan, WI 53115-1249
Phone
(262) 728-9117
NPI assigned
Mar 4, 2015
Organization subpart
No

Authorized official

Name
Genie Kuble
Title
Contact Officer
Phone
(920) 450-0157

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Tax ID family
Delavan Family Dental (2 organizations share this tax ID)

Locations

614 E Walworth Ave
Delavan, WI 53115
Phone (262) 728-9117

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry
Group: 193400000X SINGLE SPECIALTY GROUP
1223G0001X Yes

Addresses

Primary practice location

614 E Walworth Ave
Delavan, WI 53115-1249

Mailing address

614 E Walworth Ave
Delavan, WI 53115-1249

Other providers in Delavan, WI

All providers in Delavan, WI · General Practice Dentistry in Wisconsin

Sources for this page

Verify at the official NPI Registry.