The Grove Family Dental and Tmj Clinic, LLC

NPI #1295933430 in Evansville, Wisconsin

Provider Information

NPI Number: 1295933430
Entity Type: Organization
Organization Name: The Grove Family Dental and Tmj Clinic, LLC
Primary Specialty: Dentist
Enumeration Date: Jul 10, 2007
Last Updated: Jul 10, 2007

Practice Location

Address: 109 S MADISON ST
City: Evansville
State: Wisconsin
ZIP Code: 53536-1319
Phone: (608) 882-4441

Authorized Official

Name: DR. JOHN CHARLES GERNETZKE, DDS
Title: MEMBER
Phone: (608) 882-4441

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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