Organization
BELLE CITY FAMILY DENTISTRY, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIMBERLY OLESEN D.D.S. (PRESIDENT)
(262) 497-5374
Entity
Organization
Contact information
Practice address
1300 S GREEN BAY RD, SUITE 206, RACINE, WI 53406
(262) 633-4000
Mailing address
1300 S GREEN BAY RD, SUITE 206, RACINE, WI 53406
(262) 633-4000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7238-15
WI
1223P0700X
Prosthodontics
5001949-015
WI
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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