# LA CROSSE PEDIATRIC DENTISTRY LLC

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

## Provider details

- **NPI number:** 1831550813
- **Authorized official:** DR. JONATHAN M HANKS DDS (ONWER/DDS)
- **Authorized official phone:** (608) 782-4054

## Contact information

- **Practice address:** 2 COPELAND AVE STE 203, LA CROSSE, WI 54603-3419
- **Practice address phone:** (608) 782-4054
- **Practice address fax:** (608) 782-2198
- **Mailing address:** 2 COPELAND AVE STE 203, LA CROSSE, WI 54603-3419
- **Mailing address phone:** (608) 782-4054
- **Mailing address fax:** (608) 782-2198

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 1001174-15 | WI | Yes |

## Other

- **Enumeration date:** 03/17/2016
- **Last updated:** 03/17/2016