De Pere Family Dentistry LLC

NPI #1225307267 in De Pere, Wisconsin

Provider Information

NPI Number: 1225307267
Entity Type: Organization
Organization Name: De Pere Family Dentistry LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Dec 20, 2011
Last Updated: Dec 20, 2011

Practice Location

Address: 1001 N BROADWAY
City: De Pere
State: Wisconsin
ZIP Code: 54115-2609
Phone: (920) 336-2500

Authorized Official

Name: DR. CYRIL JOSEPH VAN SISTINE JR., D.D.S.
Title: PARTNER / MANAGER
Phone: (920) 336-2500

Specialties & Taxonomy Codes

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

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