Provider Demographics
NPI:1962631952
Name:SDC DENTAL HYGIENE CONCEPTS LLC
Entity Type:Organization
Organization Name:SDC DENTAL HYGIENE CONCEPTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BEAUPRE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:920-242-2209
Mailing Address - Street 1:5135 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54230-9182
Mailing Address - Country:US
Mailing Address - Phone:920-242-2209
Mailing Address - Fax:
Practice Address - Street 1:5135 GROVE RD
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54230-9182
Practice Address - Country:US
Practice Address - Phone:920-242-2209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6637-016302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization