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Fowler Memorial Free Dental Clinic

NPI #1073754024 in Monroe, Wisconsin

Provider Information

NPI Number
1073754024
Entity Type
Organization
Organization Name
Fowler Memorial Free Dental Clinic
Primary Specialty
Dentist - General Practice
Enumeration Date
Mar 19, 2009
Last Updated
Mar 19, 2009

Practice Location

Address
N3150 HIGHWAY 81
Address 2
SUITE B-14
City
Monroe
State
Wisconsin
ZIP Code
53566-9397
Phone
(608) 328-9404

Authorized Official

Name
ANNAMARIA BLIVEN, M.A.
Title
CLINIC COORDINATOR
Phone
(608) 558-2948

Specialties & Taxonomy Codes

Specialty
Dentist - General Practice — General Practice

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