Shane Dental LLC

NPI #1205361862 in Hudson, Wisconsin

Provider Information

NPI Number: 1205361862
Entity Type: Organization
Organization Name: Shane Dental LLC
Primary Specialty: Dentist
Enumeration Date: Apr 20, 2017
Last Updated: Apr 20, 2017

Practice Location

Address: 108 WALNUT ST UNIT A
City: Hudson
State: Wisconsin
ZIP Code: 54016-4501
Phone: (715) 386-2133

Authorized Official

Name: DR. KELVIN SHANE, DDS
Title: OWNER
Phone: (715) 386-2133

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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