Organization
NORTHWEST WISCONSIN UPPER PENINSULA DENTAL PC
Active
Other names
N E W UP Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD THOMAS PARK DDS (HALF OWNER)
(906) 863-2206
Entity
Organization
Contact information
Practice address
4103 10TH ST, MENOMINEE, MI 49858-1309
(906) 863-2206
(906) 863-6389
Mailing address
4103 10TH ST, MENOMINEE, MI 49858-1309
(906) 863-2206
(906) 863-6389
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901010258
MI
122300000X
Dentist
2901017418
MI
Other
Enumeration date
05/21/2008
Last updated
05/21/2008
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