Direct Denture Service

NPI #1649607730 in Sparta, Wisconsin

Provider Information

NPI Number: 1649607730
Entity Type: Organization
Organization Name: Direct Denture Service
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Oct 3, 2013
Last Updated: Oct 3, 2013

Practice Location

Address: 3000 RILEY RD
City: Sparta
State: Wisconsin
ZIP Code: 54656-6726
Phone: (608) 518-2859

Authorized Official

Name: DR. STEPHEN JOHNSTON
Title: DENTIST
Phone: (608) 518-2859

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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