Organization
MDC CASTLE ROCK
Active
Other names
Castle Rock Dental
Organization subpart
No
Provider details
NPI number
Authorized official
BERNARD BOLKA (CFO)
(920) 579-3188
Entity
Organization
Contact information
Practice address
205 DIVISION ST, MAUSTON, WI 53948-2109
(608) 847-5572
Mailing address
PO BOX 1658, FOND DU LAC, WI 54936-1658
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/24/2019
Last updated
06/24/2019
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