Provider Demographics
NPI:1134111974
Name:MAPLE GROVE DENTAL SC
Entity Type:Organization
Organization Name:MAPLE GROVE DENTAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:TAUSCHEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-848-5680
Mailing Address - Street 1:6627 MCKEE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-5023
Mailing Address - Country:US
Mailing Address - Phone:608-848-5680
Mailing Address - Fax:608-848-5681
Practice Address - Street 1:6627 MCKEE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-5023
Practice Address - Country:US
Practice Address - Phone:608-848-5680
Practice Address - Fax:608-848-5681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI3998122300000X
OH30018639122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty