Provider Demographics
NPI:1497115232
Name:APPLETON DENTAL CARE, P.A.
Entity Type:Organization
Organization Name:APPLETON DENTAL CARE, P.A.
Other - Org Name:APPLETON DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-289-2241
Mailing Address - Street 1:32 S BEHL ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:MN
Mailing Address - Zip Code:56208-1616
Mailing Address - Country:US
Mailing Address - Phone:320-289-2241
Mailing Address - Fax:
Practice Address - Street 1:32 S BEHL ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:MN
Practice Address - Zip Code:56208-1616
Practice Address - Country:US
Practice Address - Phone:320-289-2241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-06
Last Update Date:2016-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13010261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental