Provider Demographics
NPI:1912748773
Name:BADGER SMILES LLC
Entity type:Organization
Organization Name:BADGER SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:COWGILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-707-1000
Mailing Address - Street 1:2850 MIDWEST DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-6751
Mailing Address - Country:US
Mailing Address - Phone:608-707-1000
Mailing Address - Fax:
Practice Address - Street 1:2850 MIDWEST DR STE 102
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-6751
Practice Address - Country:US
Practice Address - Phone:608-707-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental