Menomonie Dental, LLC

NPI #1972016830 in Menomonie, Wisconsin

Provider Information

NPI Number: 1972016830
Entity Type: Organization
Organization Name: Menomonie Dental, LLC
Primary Specialty: Dentist
Enumeration Date: Nov 14, 2017
Last Updated: Nov 14, 2017

Practice Location

Address: 1603 STOUT RD
City: Menomonie
State: Wisconsin
ZIP Code: 54751-2989
Phone: (715) 235-6858

Authorized Official

Name: OLGA GRENOVA
Title: DIRECTOR OF ACCOUNTING
Phone: (608) 833-2213

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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