Organization
DE PERE FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CYRIL JOSEPH VAN SISTINE JR. D.D.S. (PARTNER / MANAGER)
(920) 336-2500
Entity
Organization
Contact information
Practice address
1001 N BROADWAY, DE PERE, WI 54115-2609
(920) 336-2500
(920) 336-4684
Mailing address
1001 N BROADWAY, DE PERE, WI 54115-2609
(920) 336-2500
(920) 336-4684
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5001499
WI
Other
Enumeration date
12/20/2011
Last updated
12/20/2011
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