Provider Demographics
NPI:1033542949
Name:MONONA DENTAL II, LLC
Entity Type:Organization
Organization Name:MONONA DENTAL II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GISWOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-222-9146
Mailing Address - Street 1:502 RIVER PL
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-4033
Mailing Address - Country:US
Mailing Address - Phone:608-222-9146
Mailing Address - Fax:608-222-8164
Practice Address - Street 1:502 RIVER PL
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-4033
Practice Address - Country:US
Practice Address - Phone:608-222-9146
Practice Address - Fax:608-222-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WID5253-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty