Provider Demographics
NPI:1023565686
Name:BELLE CITY FAMILY DENTISTRY, S.C.
Entity Type:Organization
Organization Name:BELLE CITY FAMILY DENTISTRY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLESEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-497-5374
Mailing Address - Street 1:1300 S GREEN BAY RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406
Mailing Address - Country:US
Mailing Address - Phone:262-633-4000
Mailing Address - Fax:
Practice Address - Street 1:1300 S GREEN BAY RD
Practice Address - Street 2:SUITE 206
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406
Practice Address - Country:US
Practice Address - Phone:262-633-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7238-15122300000X
WI5001949-0151223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty