Organization
OAK GROVE DENTAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SARA HEINEMEYER (ADMINISTRATIVE ASSISTANT)
(920) 733-4787
Entity
Organization
Contact information
Practice address
1640 MAIN ST, GREEN BAY, WI 54302-2639
(920) 468-6371
Mailing address
1640 MAIN ST, GREEN BAY, WI 54302-2639
(920) 468-6371
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5001068G
WI
Other
Enumeration date
05/09/2017
Last updated
05/09/2017
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