Provider Demographics
NPI:1063283265
Name:NO FEAR DENTISTRY SUN PRAIRIE LLC
Entity type:Organization
Organization Name:NO FEAR DENTISTRY SUN PRAIRIE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:DUCOMMUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-444-1419
Mailing Address - Street 1:180 WILBURN RD
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590
Mailing Address - Country:US
Mailing Address - Phone:608-837-4880
Mailing Address - Fax:608-837-8515
Practice Address - Street 1:180 WILBURN RD
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590
Practice Address - Country:US
Practice Address - Phone:608-837-4880
Practice Address - Fax:608-837-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty