Grand Avenue Dental Care, LLC

NPI #1255102323 in Hartford, Wisconsin

Provider Information

NPI Number
1255102323
Entity Type
Organization
Organization Name
Grand Avenue Dental Care, LLC
Primary Specialty
Clinic/Center - Dental
Enumeration Date
Jan 9, 2024
Last Updated
Jan 9, 2024

Practice Location

Address
1163 GRAND AVE
ZIP Code
53027-2458
Phone
(262) 673-7826

Authorized Official

Name
DR. LEAH NICOLE CLANCY, DDS
Title
OWNER
Phone
(708) 738-5438

Specialties & Taxonomy Codes

Specialty
Clinic/Center - DentalDental

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