Provider Demographics
NPI:1366545436
Name:ADVANCED CARE SMILE CENTER SC
Entity type:Organization
Organization Name:ADVANCED CARE SMILE CENTER SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KRAHENBUHL
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:920-233-0400
Mailing Address - Street 1:1720 CONGRESS AV
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901
Mailing Address - Country:US
Mailing Address - Phone:920-233-0400
Mailing Address - Fax:920-730-1114
Practice Address - Street 1:1720 CONGRESS AV
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901
Practice Address - Country:US
Practice Address - Phone:920-233-0400
Practice Address - Fax:920-730-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental