Provider Demographics
NPI:1245727940
Name:DODGEVILLE DENTAL LLC
Entity type:Organization
Organization Name:DODGEVILLE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-935-5262
Mailing Address - Street 1:703 N BEQUETTE ST
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1109
Mailing Address - Country:US
Mailing Address - Phone:608-935-5262
Mailing Address - Fax:608-930-5265
Practice Address - Street 1:703 N BEQUETTE ST
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1109
Practice Address - Country:US
Practice Address - Phone:608-935-5262
Practice Address - Fax:608-930-5265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental