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Organization
MADISON DENTAL LLC
Active
Organization
MADISON DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY BARES (OWNER)
(309) 369-3284
Entity
Organization
Contact information
Practice address
2110 FORDEM AVE, MADISON, WI 53704-4610
(608) 244-9124
Mailing address
2110 FORDEM AVE, MADISON, WI 53704-4610
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/11/2017
Last updated
09/11/2017
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