Provider Demographics
NPI:1083056600
Name:MDC APPLETON S
Entity Type:Organization
Organization Name:MDC APPLETON S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUTHE
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-948-6407
Mailing Address - Street 1:101 CAMELOT DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-8048
Mailing Address - Country:US
Mailing Address - Phone:920-948-6407
Mailing Address - Fax:
Practice Address - Street 1:1707 S ONEIDA ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1302
Practice Address - Country:US
Practice Address - Phone:920-734-2392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty