Provider Demographics
NPI:1194241216
Name:NORTH APPLETON DENTISTRY, LLC
Entity type:Organization
Organization Name:NORTH APPLETON DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZENMAIER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:920-734-7730
Mailing Address - Street 1:W5840 GERANIUM DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-5662
Mailing Address - Country:US
Mailing Address - Phone:920-954-8216
Mailing Address - Fax:
Practice Address - Street 1:3521 COMMERCE CT
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-8579
Practice Address - Country:US
Practice Address - Phone:920-734-7730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1255348637OtherDENTAL
WI1023464344OtherDENTAL
WI1144676990OtherDENTAL
WI1578874426OtherDENTAL