# CHILDREN'S DENTAL CENTER OF MADISON, S.C.

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

## Provider details

- **NPI number:** 1417169160
- **Authorized official:** DR. TIMOTHY R KINZEL DDS (VICE-PRESIDENT)
- **Authorized official phone:** (608) 833-6545

## Contact information

- **Practice address:** 7001 OLD SAUK ROAD, \#200, MADISON, WI 53717
- **Practice address phone:** (608) 833-6545
- **Practice address fax:** (608) 833-8516
- **Mailing address:** 7001 OLD SAUK ROAD, \#200, MADISON, WI 53717
- **Mailing address phone:** (608) 833-6545
- **Mailing address fax:** (608) 833-8516

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | WI3347 | WI | Yes |

## Other

- **Enumeration date:** 05/04/2007
- **Last updated:** 06/24/2008