Provider Demographics
NPI:1740792969
Name:GREAT DAY DENTAL LLC
Entity Type:Organization
Organization Name:GREAT DAY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:608-221-3326
Mailing Address - Street 1:1532 W BROADWAY STE 101
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1827
Mailing Address - Country:US
Mailing Address - Phone:608-221-3326
Mailing Address - Fax:608-221-9726
Practice Address - Street 1:1532 W BROADWAY STE 101
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-1827
Practice Address - Country:US
Practice Address - Phone:608-221-3326
Practice Address - Fax:608-221-9726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6337261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental