Provider Demographics
NPI:1962658609
Name:SZMANDA DENTAL CENTER, SC
Entity Type:Organization
Organization Name:SZMANDA DENTAL CENTER, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:WELLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-845-3200
Mailing Address - Street 1:107 S. 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:EDGAR
Mailing Address - State:WI
Mailing Address - Zip Code:54426-9281
Mailing Address - Country:US
Mailing Address - Phone:715-352-2700
Mailing Address - Fax:
Practice Address - Street 1:107 S. 3RD AVE
Practice Address - Street 2:
Practice Address - City:EDGAR
Practice Address - State:WI
Practice Address - Zip Code:54426-9281
Practice Address - Country:US
Practice Address - Phone:715-352-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SZMANDA DENTAL CENTER SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-13
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty