Provider Demographics
NPI:1306092044
Name:SZMANDA DENTAL CENTER
Entity type:Organization
Organization Name:SZMANDA DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SZMANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-845-3200
Mailing Address - Street 1:202 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WITTENBERG
Mailing Address - State:WI
Mailing Address - Zip Code:54499-9113
Mailing Address - Country:US
Mailing Address - Phone:715-253-3200
Mailing Address - Fax:
Practice Address - Street 1:202 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:WITTENBERG
Practice Address - State:WI
Practice Address - Zip Code:54499-9113
Practice Address - Country:US
Practice Address - Phone:715-253-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50015541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty