Organization
THE GROVE FAMILY DENTAL AND TMJ CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN CHARLES GERNETZKE DDS (MEMBER)
(608) 882-4441
Entity
Organization
Contact information
Practice address
109 S MADISON ST, EVANSVILLE, WI 53536-1319
(608) 882-4441
Mailing address
109 S MADISON ST, EVANSVILLE, WI 53536-1319
(608) 882-4441
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4078
WI
Other
Enumeration date
07/10/2007
Last updated
07/10/2007
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