Provider Demographics
NPI:1871815035
Name:ARTISTIC SMILES DENTISTRY S.C.
Entity Type:Organization
Organization Name:ARTISTIC SMILES DENTISTRY S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-968-5000
Mailing Address - Street 1:3825 E CALUMET ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-4159
Mailing Address - Country:US
Mailing Address - Phone:920-968-5000
Mailing Address - Fax:920-968-5002
Practice Address - Street 1:3825 E CALUMET ST
Practice Address - Street 2:SUITE 600
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-4159
Practice Address - Country:US
Practice Address - Phone:920-968-5000
Practice Address - Fax:920-968-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty