Provider Demographics
NPI:1306098397
Name:LA CROSSE COMMUNITY DENTAL
Entity type:Organization
Organization Name:LA CROSSE COMMUNITY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOEFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-797-3160
Mailing Address - Street 1:1300 BADGER ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-1502
Mailing Address - Country:US
Mailing Address - Phone:608-782-2840
Mailing Address - Fax:
Practice Address - Street 1:1300 BADGER ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-1502
Practice Address - Country:US
Practice Address - Phone:608-782-2840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental