Provider Demographics
NPI:1427201599
Name:WEST BEND DENTAL CENTER SC
Entity type:Organization
Organization Name:WEST BEND DENTAL CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:SALZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-338-0022
Mailing Address - Street 1:1500 S. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095
Mailing Address - Country:US
Mailing Address - Phone:262-338-0022
Mailing Address - Fax:262-338-7982
Practice Address - Street 1:1500 S MAIN ST.
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095
Practice Address - Country:US
Practice Address - Phone:262-338-0022
Practice Address - Fax:262-338-7982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty