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Organization
MATC DENTAL HYGIENE CLINIC
Active
Organization
MATC DENTAL HYGIENE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
E. LYNN GOETSCH RDH (CLINIC SUPERVISOR)
(608) 258-2470
Entity
Organization
Contact information
Practice address
211 N CARROLL ST, MADISON, WI 53703-2211
(608) 258-2400
Mailing address
211 N CARROLL ST, MADISON, WI 53703-2211
(608) 258-2400
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
NULL
122300000X
Dentist
—
—
124Q00000X
Dental Hygienist
Primary
—
NULL
124Q00000X
Dental Hygienist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38382500
—
WI
Enumeration date
09/04/2008
Last updated
09/04/2008
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