Provider Demographics
NPI:1376951673
Name:MDC RIPON SC
Entity Type:Organization
Organization Name:MDC RIPON SC
Other - Org Name:RIPON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAUTHE
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-921-1244
Mailing Address - Street 1:54 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4204
Mailing Address - Country:US
Mailing Address - Phone:920-602-0007
Mailing Address - Fax:
Practice Address - Street 1:106 WATSON ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-1327
Practice Address - Country:US
Practice Address - Phone:920-748-7731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI68331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty