Provider Demographics
NPI:1710509484
Name:HOSPITAL DENTISTRY FOR KIDS INC.
Entity Type:Organization
Organization Name:HOSPITAL DENTISTRY FOR KIDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:RAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-664-2424
Mailing Address - Street 1:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:DENMARK
Mailing Address - State:WI
Mailing Address - Zip Code:54208-0560
Mailing Address - Country:US
Mailing Address - Phone:920-664-2424
Mailing Address - Fax:
Practice Address - Street 1:4980 S COUNTY RD T
Practice Address - Street 2:
Practice Address - City:DENMARK
Practice Address - State:WI
Practice Address - Zip Code:54208
Practice Address - Country:US
Practice Address - Phone:920-664-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty