Idental
NPI #1508316753 in Mount Pleasant, Wisconsin
Provider Information
- NPI Number
- 1508316753
- Entity Type
- Organization
- Organization Name
- Idental
- Primary Specialty
- Dental Hygienist
- Enumeration Date
- Oct 12, 2016
- Last Updated
- Nov 16, 2016
Practice Location
- Address
- 1320 S GREEN BAY RD
- City
- Mount Pleasant
- State
- Wisconsin
- ZIP Code
- 53406-4402
- Phone
- (262) 223-0280
Authorized Official
- Name
- MS. MARIAN 'TRACIE' CLUBB
- Title
- ASSISTANT MANAGER
- Phone
- (262) 223-0280
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dental Hygienist |
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