Provider Demographics
NPI:1952773426
Name:DOOR COUNTY DENTAL CARE
Entity Type:Organization
Organization Name:DOOR COUNTY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-743-6911
Mailing Address - Street 1:30 N 18TH AVE
Mailing Address - Street 2:2
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-3207
Mailing Address - Country:US
Mailing Address - Phone:920-743-6911
Mailing Address - Fax:920-743-5890
Practice Address - Street 1:30 N 18TH AVE
Practice Address - Street 2:2
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-3207
Practice Address - Country:US
Practice Address - Phone:920-743-6911
Practice Address - Fax:920-743-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty