Organization
EASTRIDGE DENTAL ASSOCIATES, S.C.
Active
Other names
Eastridge Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN E. PATRICKUS DDS (PRESIDENT)
(920) 468-8144
Entity
Organization
Contact information
Practice address
2343 E MASON ST, GREEN BAY, WI 54302-3764
(920) 468-8144
Mailing address
2343 E. MASON STREET, GREEN BAY, WI 54302
(920) 468-8144
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
01/16/2007
Last updated
07/01/2008
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