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Organization
CESA #11 RURAL HEALTH DENTAL CLINIC
Active
Organization
CESA #11 RURAL HEALTH DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHARON HAUGERUD (DIRECTOR)
(715) 986-2020
Entity
Organization
Contact information
Practice address
3375 KOTHLOW AVE., SUITE 40, MENOMONIE, WI 54751
(715) 235-1573
(715) 235-2081
Mailing address
225 OSTERMANN DR, TURTLE LAKE, WI 54889-9191
(715) 986-2020
(715) 986-2041
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38389000
—
WI
Enumeration date
05/24/2007
Last updated
08/06/2008
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