Provider Demographics
NPI:1760112247
Name:DANE DENTAL LLC
Entity Type:Organization
Organization Name:DANE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:SPAULDING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-456-5148
Mailing Address - Street 1:3066 SHADYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-3244
Mailing Address - Country:US
Mailing Address - Phone:715-456-5148
Mailing Address - Fax:
Practice Address - Street 1:4705 DALE CURTIN DR
Practice Address - Street 2:
Practice Address - City:MCFARLAND
Practice Address - State:WI
Practice Address - Zip Code:53558-8958
Practice Address - Country:US
Practice Address - Phone:608-838-7474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental