Provider Demographics
NPI:1780182758
Name:DOWDEN CD LLC
Entity Type:Organization
Organization Name:DOWDEN CD LLC
Other - Org Name:CORNERSTONE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-870-3072
Mailing Address - Street 1:1713 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-1545
Mailing Address - Country:US
Mailing Address - Phone:262-334-4083
Mailing Address - Fax:262-334-4996
Practice Address - Street 1:1713 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090-1545
Practice Address - Country:US
Practice Address - Phone:262-334-4083
Practice Address - Fax:262-334-4996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7242-15261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental