Provider Demographics
NPI:1417345307
Name:DENTURESMART DENTURE SERVICE LLC
Entity Type:Organization
Organization Name:DENTURESMART DENTURE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CORTOPASSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-519-3946
Mailing Address - Street 1:605 2ND AVE S
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-3388
Mailing Address - Country:US
Mailing Address - Phone:608-519-3946
Mailing Address - Fax:608-519-3947
Practice Address - Street 1:605 2ND AVE S
Practice Address - Street 2:STE 130
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-3388
Practice Address - Country:US
Practice Address - Phone:608-519-3946
Practice Address - Fax:608-519-3947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126900000XDental ProvidersDental Laboratory TechnicianGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty