Provider Demographics
NPI:1952592420
Name:ORAL HEALTH CLINIC INC
Entity Type:Organization
Organization Name:ORAL HEALTH CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIEGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-648-2327
Mailing Address - Street 1:135 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-1609
Mailing Address - Country:US
Mailing Address - Phone:920-648-2327
Mailing Address - Fax:
Practice Address - Street 1:135 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-1609
Practice Address - Country:US
Practice Address - Phone:920-648-2327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2336122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty