Provider Demographics
NPI:1295819134
Name:COMPLETE DENTAL CENTER, S.C.
Entity Type:Organization
Organization Name:COMPLETE DENTAL CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KREBS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-627-1000
Mailing Address - Street 1:408 STATE HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-8796
Mailing Address - Country:US
Mailing Address - Phone:715-627-1000
Mailing Address - Fax:715-627-7123
Practice Address - Street 1:408 STATE HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-8796
Practice Address - Country:US
Practice Address - Phone:715-627-1000
Practice Address - Fax:715-627-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty