Upper Lakes Dental, LLC
NPI #1124580352 in Winneconne, Wisconsin
Provider Information
- NPI Number
- 1124580352
- Entity Type
- Organization
- Organization Name
- Upper Lakes Dental, LLC
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Apr 5, 2019
- Last Updated
- Apr 5, 2019
Practice Location
- Address
- 908 E MAIN ST STE C
- City
- Winneconne
- State
- Wisconsin
- ZIP Code
- 54986-9672
- Phone
- (920) 582-0688
Authorized Official
- Name
- DR. RYAN GONZALEZ, D.D.S.
- Title
- OWNER
- Phone
- (920) 582-0688
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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