Provider Demographics
NPI:1891937090
Name:SOUTHWESTERN WISCONSIN COMMUNITY ACTION PROGRAM
Entity Type:Organization
Organization Name:SOUTHWESTERN WISCONSIN COMMUNITY ACTION PROGRAM
Other - Org Name:DENTAL HYGIENE SERVICES AND DENTAL REFERRAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:ORZECHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MSPH, MBA
Authorized Official - Phone:608-935-2326
Mailing Address - Street 1:275 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-3110
Mailing Address - Country:US
Mailing Address - Phone:608-348-9766
Mailing Address - Fax:608-348-3915
Practice Address - Street 1:275 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-3110
Practice Address - Country:US
Practice Address - Phone:608-348-9766
Practice Address - Fax:608-348-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4521016251K00000X
WI139651030251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1538311048Medicaid