Organization
GREAT RIVER ORTHODONTIC SPECIALISTS, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA SAWYER (DIRECTOR OF OPERATIONS)
(715) 835-5182
Entity
Organization
Contact information
Practice address
1200 MAIN ST, LA CROSSE, WI 54601-4468
(608) 782-6778
Mailing address
3902 OAKWOOD HILLS PKWY, EAU CLAIRE, WI 54701-7780
(715) 835-5182
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
1001026
WI
Other
Enumeration date
08/22/2016
Last updated
08/22/2016
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