Organization
MDC NORTH FONDY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM MAUTHE III (OWNER)
(920) 948-6407
Entity
Organization
Contact information
Practice address
825 PROSPECT AVE, NORTH FOND DU LAC, WI 54937-1365
(920) 923-0310
Mailing address
101 CAMELOT DR, SUITE 3, FOND DU LAC, WI 54935-8048
(920) 948-6407
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/24/2013
Last updated
07/24/2013
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