Wolf River Dental LLC

NPI #1144684002 in Shawano, Wisconsin

Provider Information

NPI Number: 1144684002
Entity Type: Organization
Organization Name: Wolf River Dental LLC
Subpart: Yes (part of a larger organization)
Parent Organization: STEPPING STONE DENTAL LLC
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Apr 7, 2016
Last Updated: Apr 7, 2016

Practice Location

Address: 152 WOODLAWN DR
City: Shawano
State: Wisconsin
ZIP Code: 54166-2200
Phone: (715) 526-3314

Authorized Official

Name: TIMOTHY MATHISON
Title: PRESIDENT & CEO
Phone: (608) 709-8303

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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