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Organization
DELTA DENTAL OF WISCONSIN FOUNDATION INC
Active
Organization
DELTA DENTAL OF WISCONSIN FOUNDATION INC
Active
Other names
Smile Club
Organization subpart
No
Provider details
NPI number
Authorized official
ANN BOSON (EXECUTIVE DIRECTOR)
(715) 343-7209
Entity
Organization
Contact information
Practice address
941 MICHIGAN AVE, STEVENS POINT, WI 54481
(715) 204-1180
(715) 204-3901
Mailing address
PO BOX 828, STEVENS POINT, WI 54481-0828
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1002005-15
STATE LICENSE
WI
01
—
1002597-16
STATE LICENSE
WI
01
—
5495-015
STATE LICENSE
WI
Enumeration date
09/08/2021
Last updated
09/08/2021
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