Provider Demographics
NPI:1194859215
Name:WEBSTER DENTAL ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:WEBSTER DENTAL ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:JON
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-435-1998
Mailing Address - Street 1:2121 S WEBSTER AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2290
Mailing Address - Country:US
Mailing Address - Phone:920-435-1998
Mailing Address - Fax:920-435-1399
Practice Address - Street 1:2121 S WEBSTER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2290
Practice Address - Country:US
Practice Address - Phone:920-435-1998
Practice Address - Fax:920-435-1399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5000528122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty