Provider Demographics
NPI:1578823530
Name:OAKWOOD HILLS FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:OAKWOOD HILLS FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MISKULIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-834-5882
Mailing Address - Street 1:3119 GOLF RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7006
Mailing Address - Country:US
Mailing Address - Phone:715-834-5882
Mailing Address - Fax:715-834-1988
Practice Address - Street 1:3119 GOLF RD
Practice Address - Street 2:SUITE 107
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7006
Practice Address - Country:US
Practice Address - Phone:715-834-5882
Practice Address - Fax:715-834-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6278-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty