Organization
WOODLAND DENTAL GRP., SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLS LAWRENCE NELSON DDS (PRESIDENT)
(262) 662-3066
Entity
Organization
Contact information
Practice address
W232S7590 WOODLAND LN, BIG BEND, WI 53103-9651
(262) 662-3066
(262) 662-2070
Mailing address
W232S7590 WOODLAND LN, BIG BEND, WI 53103-9651
(262) 662-3066
(262) 662-2070
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3326
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
79300
WPS#
WI
Enumeration date
07/22/2006
Last updated
08/22/2020
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