Provider Demographics
NPI:1043719602
Name:VENEMAN DENTAL CARE, LLC
Entity Type:Organization
Organization Name:VENEMAN DENTAL CARE, LLC
Other - Org Name:VENEMAN DENTAL CARE, WOODVILLE WI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:VENEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-303-3203
Mailing Address - Street 1:131 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54028-9545
Mailing Address - Country:US
Mailing Address - Phone:715-483-9705
Mailing Address - Fax:
Practice Address - Street 1:131 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:WI
Practice Address - Zip Code:54028-9545
Practice Address - Country:US
Practice Address - Phone:715-483-9705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3669261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental