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Organization

ELITE SMILES DENTAL, LTD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ALISSA EDWARDS D.D.S. (DENTIST)
(920) 731-2211
Entity
Organization

Contact information

Practice address
315 W WISCONSIN AVE, APPLETON, WI 54911-4355
(920) 731-2211
(920) 733-7176
Mailing address
315 W WISCONSIN AVE, APPLETON, WI 54911-4355
(920) 731-2211
(920) 733-7176

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6542-15
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1578874426
NPI TYPE 1
WI
01
6542-15
LICENSE NUMBER
WI
Enumeration date
02/24/2016
Last updated
02/24/2016
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