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Organization
FOX VALLEY DENTAL CENTER
Active
Organization
FOX VALLEY DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATIE LEAH HAREID DDS (OWNER/MEMBER)
(415) 307-6025
Entity
Organization
Contact information
Practice address
760 W NORTHLAND AVE, APPLETON, WI 54914-1425
(920) 731-7717
(920) 733-6014
Mailing address
315 KRAFT ST, NEENAH, WI 54956-4988
(415) 307-6025
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1972751923
INDIVIDUAL NPI
—
Enumeration date
09/22/2022
Last updated
09/22/2022
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