Provider Demographics
NPI:1164031464
Name:CENTRAL WISCONSIN ENDODONTIC SPECIALISTS LLC
Entity Type:Organization
Organization Name:CENTRAL WISCONSIN ENDODONTIC SPECIALISTS LLC
Other - Org Name:MPC ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:WEILAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-343-0818
Mailing Address - Street 1:2606 STEWART AVENUE
Mailing Address - Street 2:#102
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2606 STEWART AVENUE
Practice Address - Street 2:#102
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-848-3982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty