Organization
GILLETT DENTAL CARE, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EVELYN KATRINA HAUSER-FREDERICK (PRESIDENT)
(920) 855-2155
Entity
Organization
Contact information
Practice address
137 E MAIN ST, GILLETT, WI 54124-9386
(920) 855-6091
Mailing address
137 E MAIN ST, P.O. BOX 266, GILLETT, WI 54124-9386
(920) 855-6091
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5002024-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33374500
—
WI
01
—
5002024-015
STATE DENTAL LICENSE
WI
Enumeration date
05/08/2007
Last updated
06/17/2014
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