Provider Demographics
NPI:1164536967
Name:DOWNTOWN FAMILY DENTAL OF BARABOO
Entity Type:Organization
Organization Name:DOWNTOWN FAMILY DENTAL OF BARABOO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-356-3790
Mailing Address - Street 1:147 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-2423
Mailing Address - Country:US
Mailing Address - Phone:608-356-3790
Mailing Address - Fax:608-356-7863
Practice Address - Street 1:147 3RD ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-2423
Practice Address - Country:US
Practice Address - Phone:608-356-3790
Practice Address - Fax:608-356-7863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental