Organization
FAMILY DENTISTRY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN LEE MIKE DDS (DENTIST)
(715) 246-6493
Entity
Organization
Contact information
Practice address
135 W SECOND STREET, NEW RICHMOND, WI 54017
(715) 246-6603
(715) 246-6649
Mailing address
135 W SECOND STREET, PO BOX 55, NEW RICHMOND, WI 54017
(715) 246-6603
(715) 246-6649
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38370900
—
WI
Enumeration date
11/02/2006
Last updated
08/22/2020
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