Provider Demographics
NPI:1497164255
Name:DHC SC
Entity Type:Organization
Organization Name:DHC SC
Other - Org Name:DHC SC CADOTT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INSURANCE CO ORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-832-3100
Mailing Address - Street 1:418 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CADOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54727-9604
Mailing Address - Country:US
Mailing Address - Phone:715-289-4922
Mailing Address - Fax:715-289-4922
Practice Address - Street 1:418 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CADOTT
Practice Address - State:WI
Practice Address - Zip Code:54727-9604
Practice Address - Country:US
Practice Address - Phone:715-289-4922
Practice Address - Fax:715-289-4922
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DHCSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty