# NORTHWOODS DENTISTRY, RICE LAKE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336624659
- **Authorized official:** MRS. JENNIFER STAROBA (PRACTICE MANAGER)
- **Authorized official phone:** (715) 428-2421

## Contact information

- **Practice address:** 115 E THOMAS ST, RICE LAKE, WI 54868-3055
- **Practice address phone:** (715) 234-4636
- **Practice address fax:** (715) 234-2982
- **Mailing address:** PO BOX 27, PRENTICE, WI 54556-0027
- **Mailing address phone:** (715) 428-2422
- **Mailing address fax:** (715) 428-2431

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/02/2018
- **Last updated:** 10/02/2018