Provider Demographics
NPI:1184718231
Name:MARK A LETTER DDS SC
Entity type:Organization
Organization Name:MARK A LETTER DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:LETTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-388-5200
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:1112 LINCOLN STREET
Mailing Address - City:KEWAUNEE
Mailing Address - State:WI
Mailing Address - Zip Code:54216-0198
Mailing Address - Country:US
Mailing Address - Phone:920-388-5200
Mailing Address - Fax:920-388-5202
Practice Address - Street 1:1112 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:KEWAUNEE
Practice Address - State:WI
Practice Address - Zip Code:54216-0198
Practice Address - Country:US
Practice Address - Phone:920-388-5200
Practice Address - Fax:920-388-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty