Provider Demographics
NPI:1437552841
Name:DENTISTRY OF WEST BEND, LTD.
Entity Type:Organization
Organization Name:DENTISTRY OF WEST BEND, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-886-0223
Mailing Address - Street 1:1270 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3130
Mailing Address - Country:US
Mailing Address - Phone:262-334-0316
Mailing Address - Fax:
Practice Address - Street 1:1270 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3130
Practice Address - Country:US
Practice Address - Phone:262-334-0316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6537-15261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental