Provider Demographics
NPI:1629154430
Name:TOTAL CARE DENTAL, S.C.
Entity Type:Organization
Organization Name:TOTAL CARE DENTAL, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-274-1911
Mailing Address - Street 1:6317 ODANA RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1107
Mailing Address - Country:US
Mailing Address - Phone:608-274-1911
Mailing Address - Fax:608-274-1858
Practice Address - Street 1:6317 ODANA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1107
Practice Address - Country:US
Practice Address - Phone:608-274-1911
Practice Address - Fax:608-274-1858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty