Provider Demographics
NPI:1154909414
Name:AREA DENTAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:AREA DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:STROHBUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-285-7441
Mailing Address - Street 1:1149 BOUGHTON ST BLDG B
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-3104
Mailing Address - Country:US
Mailing Address - Phone:920-261-0495
Mailing Address - Fax:920-261-3632
Practice Address - Street 1:1149 BOUGHTON ST BLDG B
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-3104
Practice Address - Country:US
Practice Address - Phone:920-261-0495
Practice Address - Fax:920-261-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619077583OtherNPI
1467509430OtherNPI
1013220516OtherNPI
1427293620OtherNPI
1225659352OtherNPI