Advanced Dental Specialists, LLC

NPI #1578213484 in Appleton, Wisconsin

Provider Information

NPI Number: 1578213484
Entity Type: Organization
Organization Name: Advanced Dental Specialists, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: ADVANCED DENTAL SPECIALISTS, LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 24, 2022
Last Updated: Mar 24, 2022

Practice Location

Address: 2476 N ONEIDA ST STE 150
City: Appleton
State: Wisconsin
ZIP Code: 54911
Phone: (920) 954-8085

Authorized Official

Name: CELIA HAYES
Title: CREDENTIALING COORDINATOR
Phone: (217) 540-2100

Specialties & Taxonomy Codes

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

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