# CAMPFIRE PEDIATRIC DENTISTRY, LLC

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

## Provider details

- **NPI number:** 1881364958
- **Authorized official:** NATHANAEL D BENASSI DDS (MEMBER)
- **Authorized official phone:** (608) 535-9382

## Contact information

- **Practice address:** 8391 GREENWAY BLVD STE 100, MIDDLETON, WI 53562-3544
- **Practice address phone:** (815) 979-3837
- **Mailing address:** 8391 GREENWAY BLVD STE 100, MIDDLETON, WI 53562-3544
- **Mailing address phone:** (608) 535-9382

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |
| 261QD0000X | Dental Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 09/20/2021
- **Last updated:** 04/28/2022