Cesa #11 Rural Health Dental Clinic

NPI #1730390840 in Menomonie, Wisconsin

Provider Information

NPI Number: 1730390840
Entity Type: Organization
Organization Name: Cesa #11 Rural Health Dental Clinic
Primary Specialty: Clinic/Center - Dental
Enumeration Date: May 24, 2007
Last Updated: Aug 6, 2008

Practice Location

Address: 3375 KOTHLOW AVE.
Address 2: SUITE 40
City: Menomonie
State: Wisconsin
ZIP Code: 54751
Phone: (715) 235-1573

Authorized Official

Name: MS. SHARON HAUGERUD
Title: DIRECTOR
Phone: (715) 986-2020

Specialties & Taxonomy Codes

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

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