Provider Demographics
NPI:1831301290
Name:FAMILY DENTAL CENTER OF GREEN BAY, S.C.
Entity Type:Organization
Organization Name:FAMILY DENTAL CENTER OF GREEN BAY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LOCHOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-499-2560
Mailing Address - Street 1:2247 FOX HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-4747
Mailing Address - Country:US
Mailing Address - Phone:920-499-2560
Mailing Address - Fax:920-499-2260
Practice Address - Street 1:2247 FOX HEIGHTS LN
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4747
Practice Address - Country:US
Practice Address - Phone:920-499-2560
Practice Address - Fax:920-499-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty