East Grove Dental Sc

NPI #1023073178 in Madison, Wisconsin

Provider Information

NPI Number: 1023073178
Entity Type: Organization
Organization Name: East Grove Dental Sc
Primary Specialty: Dentist - General Practice
Enumeration Date: Apr 20, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 826 ATLAS AVE
City: Madison
State: Wisconsin
ZIP Code: 53714-3114
Phone: (608) 222-8344

Authorized Official

Name: MRS. SANDRA L LYSLOFF
Title: OFFICE ADMINISTRATOR
Phone: (608) 222-8344

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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