Provider Demographics
NPI:1083821169
Name:TERRENCE K FRANTAL DDS SC
Entity Type:Organization
Organization Name:TERRENCE K FRANTAL DDS SC
Other - Org Name:FRANTAL DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-694-1100
Mailing Address - Street 1:7601 PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-4321
Mailing Address - Country:US
Mailing Address - Phone:262-694-1100
Mailing Address - Fax:262-694-1103
Practice Address - Street 1:7601 PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-4321
Practice Address - Country:US
Practice Address - Phone:262-694-1100
Practice Address - Fax:262-694-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001388-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty