Organization
PRESCOTT FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASSIE LYNN ERICKSON (OFFICE MANAGER)
(715) 262-3382
Entity
Organization
Contact information
Practice address
1015 CAMPBELL ST N, PRESCOTT, WI 54021-1157
(715) 262-3382
(715) 262-3063
Mailing address
1015 CAMPBELL ST N, PRESCOTT, WI 54021-1157
(715) 262-3382
(715) 262-3063
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
3523
WI
1223G0001X
General Practice Dentistry
Primary
6932
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100024073
—
WI
05
—
33478900
—
WI
Enumeration date
12/11/2014
Last updated
03/08/2018
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