Provider Demographics
NPI:1740356229
Name:ROLAND W PARDUN DDS SC
Entity type:Organization
Organization Name:ROLAND W PARDUN DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:W
Authorized Official - Last Name:PARDUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-248-2442
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:COCHRANE
Mailing Address - State:WI
Mailing Address - Zip Code:54622-0036
Mailing Address - Country:US
Mailing Address - Phone:608-248-2442
Mailing Address - Fax:608-248-3132
Practice Address - Street 1:241 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COCHRANE
Practice Address - State:WI
Practice Address - Zip Code:54622
Practice Address - Country:US
Practice Address - Phone:608-248-2442
Practice Address - Fax:608-248-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental