Provider Demographics
NPI:1821264300
Name:MONONA RIVERPLACE DENTAL, LLC
Entity Type:Organization
Organization Name:MONONA RIVERPLACE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:ASWEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-222-9142
Mailing Address - Street 1:604 RIVER PL
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-4034
Mailing Address - Country:US
Mailing Address - Phone:608-222-9142
Mailing Address - Fax:608-226-8818
Practice Address - Street 1:604 RIVER PL
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-4034
Practice Address - Country:US
Practice Address - Phone:608-222-9142
Practice Address - Fax:608-226-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI973G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty