Provider Demographics
NPI:1003023367
Name:WINDSOR FAMILY DENTAL, S.C.
Entity Type:Organization
Organization Name:WINDSOR FAMILY DENTAL, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ENDICOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-846-5407
Mailing Address - Street 1:6729 LAKE ROAD
Mailing Address - Street 2:PO BOX 287
Mailing Address - City:WINDSOR
Mailing Address - State:WI
Mailing Address - Zip Code:53598-0000
Mailing Address - Country:US
Mailing Address - Phone:608-846-5407
Mailing Address - Fax:608-846-2493
Practice Address - Street 1:6729 LAKE ROAD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:WI
Practice Address - Zip Code:53598-0000
Practice Address - Country:US
Practice Address - Phone:608-846-5407
Practice Address - Fax:608-846-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty