Provider Demographics
NPI:1427168863
Name:OCONTO FALLS DENTAL SC
Entity type:Organization
Organization Name:OCONTO FALLS DENTAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MUNES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-846-2171
Mailing Address - Street 1:248 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154
Mailing Address - Country:US
Mailing Address - Phone:920-846-2171
Mailing Address - Fax:
Practice Address - Street 1:248 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154
Practice Address - Country:US
Practice Address - Phone:920-846-2171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty