# DENTAL HAVEN FOR CHILDREN SC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1598105637
- **Authorized official:** GONZALO E HERNANDEZ DDS (PRESIDENT)
- **Authorized official phone:** (920) 739-6808

## Contact information

- **Practice address:** 2612 E CALUMET ST, APPLETON, WI 54915-4104
- **Practice address phone:** (920) 739-6808
- **Practice address fax:** (888) 492-5007
- **Mailing address:** 2612 E CALUMET ST, APPLETON, WI 54915-4104
- **Mailing address phone:** (920) 739-6808
- **Mailing address fax:** (888) 492-5007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 4564-015 | WI | Yes |

## Other

- **Enumeration date:** 07/03/2013
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33718600 | — | WI |