Provider Demographics
NPI:1154354249
Name:DENTAL HEALTH ASSOCIATES OF MADISON, LTD
Entity type:Organization
Organization Name:DENTAL HEALTH ASSOCIATES OF MADISON, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVACY OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SKIBBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-246-2555
Mailing Address - Street 1:2971 CHAPEL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7420
Mailing Address - Country:US
Mailing Address - Phone:608-661-6432
Mailing Address - Fax:
Practice Address - Street 1:2971 CHAPEL VALLEY RD
Practice Address - Street 2:ADMINISTRATION OFFICE
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-7420
Practice Address - Country:US
Practice Address - Phone:608-661-6432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty