Provider Demographics
NPI:1699724815
Name:DENTAL CLINIC OF MARSHFIELD SC
Entity type:Organization
Organization Name:DENTAL CLINIC OF MARSHFIELD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-387-1702
Mailing Address - Street 1:PO BOX 929
Mailing Address - Street 2:306 WEST MCMILLAN ROAD
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449
Mailing Address - Country:US
Mailing Address - Phone:715-387-1702
Mailing Address - Fax:715-387-8174
Practice Address - Street 1:306 WEST MCMILLAN ROAD
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449
Practice Address - Country:US
Practice Address - Phone:715-387-1702
Practice Address - Fax:715-387-8174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty