Organization
DELTA DENTAL OF WISCONSIN FOUNDATION INC
Active
Other names
Smile Club
Organization subpart
No
Provider details
NPI number
Authorized official
ANN BOSON (EXECUTIVE DIRECTOR)
(715) 343-7209
Entity
Organization
Contact information
Practice address
941 MICHIGAN AVE, STEVENS POINT, WI 54481
(715) 204-1180
(715) 204-3901
Mailing address
PO BOX 828, STEVENS POINT, WI 54481-0828
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1002005-15
STATE LICENSE
WI
01
—
1002597-16
STATE LICENSE
WI
01
—
5495-015
STATE LICENSE
WI
Enumeration date
09/08/2021
Last updated
09/08/2021
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