Provider Demographics
NPI:1730103490
Name:CHARLES A. SOWIEJA, D.D.S., S.C.
Entity Type:Organization
Organization Name:CHARLES A. SOWIEJA, D.D.S., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOWIEJA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-536-7104
Mailing Address - Street 1:201 N CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-1265
Mailing Address - Country:US
Mailing Address - Phone:715-535-7104
Mailing Address - Fax:715-536-3759
Practice Address - Street 1:201 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-1265
Practice Address - Country:US
Practice Address - Phone:715-535-7104
Practice Address - Fax:715-536-3759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty