Organization
SHANE DENTAL LLC
Active
Other names
Shane Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELVIN SHANE DDS (OWNER)
(715) 386-2133
Entity
Organization
Contact information
Practice address
108 WALNUT ST UNIT A, HUDSON, WI 54016-4501
(715) 386-2133
Mailing address
108 WALNUT ST UNIT A, HUDSON, WI 54016-4501
(715) 386-2133
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
100148715
WI
Other
Enumeration date
04/20/2017
Last updated
04/20/2017
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