Black Creek Dental LLC
NPI #1457716763 in Black Creek, Wisconsin
Provider Information
- NPI Number
- 1457716763
- Entity Type
- Organization
- Organization Name
- Black Creek Dental LLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Dec 31, 2015
- Last Updated
- Dec 31, 2015
Practice Location
- Address
- 207 S MAIN ST
- City
- Black Creek
- State
- Wisconsin
- ZIP Code
- 54106-9742
- Phone
- (920) 984-3315
Authorized Official
- Name
- DR. THOMAS E LORNSON, DDS
- Title
- OWNER
- Phone
- (920) 984-3315
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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