Organization
EAST GROVE DENTAL SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA L LYSLOFF (OFFICE ADMINISTRATOR)
(608) 222-8344
Entity
Organization
Contact information
Practice address
826 ATLAS AVE, MADISON, WI 53714-3114
(608) 222-8344
(608) 222-8376
Mailing address
826 ATLAS AVE, MADISON, WI 53714-3114
(608) 222-8344
(608) 222-8376
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1727G
WI
1223G0001X
General Practice Dentistry
2808
WI
1223G0001X
General Practice Dentistry
Primary
5133
WI
Other
Enumeration date
04/20/2006
Last updated
08/22/2020
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