Provider Demographics
NPI:1225880271
Name:AFRESH DENTAL HEALTH, L.L.C.
Entity Type:Organization
Organization Name:AFRESH DENTAL HEALTH, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHULKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:920-544-6704
Mailing Address - Street 1:2521 MOONDANCE DR
Mailing Address - Street 2:
Mailing Address - City:KRONENWETTER
Mailing Address - State:WI
Mailing Address - Zip Code:54455-7288
Mailing Address - Country:US
Mailing Address - Phone:920-544-6704
Mailing Address - Fax:
Practice Address - Street 1:700 EAGLE NEST BLVD STE E
Practice Address - Street 2:
Practice Address - City:ROTHSCHILD
Practice Address - State:WI
Practice Address - Zip Code:54474-7995
Practice Address - Country:US
Practice Address - Phone:715-334-8331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental