Organization
JACKSON FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT WILLIAM CHARMOLI DDS (OWNER)
(262) 677-3003
Entity
Organization
Contact information
Practice address
N168W20060 MAIN ST, JACKSON, WI 53037-9382
(262) 677-3003
(262) 677-1641
Mailing address
N168W20060 MAIN ST, JACKSON, WI 53037-9382
(262) 677-3003
(262) 677-1641
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3671-15
WI
Other
Enumeration date
02/02/2015
Last updated
02/02/2015
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