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Organization

FOWLER MEMORIAL FREE DENTAL CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANNAMARIA BLIVEN M.A. (CLINIC COORDINATOR)
(608) 558-2948
Entity
Organization

Contact information

Practice address
N3150 HIGHWAY 81, SUITE B-14, MONROE, WI 53566-9397
(608) 328-9404
Mailing address
N3150 HIGHWAY 81, SUITE B-14, MONROE, WI 53566-9397
(608) 328-9404

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
03/19/2009
Last updated
03/19/2009
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