Organization
PERIODONTAL & IMPLANT SPECIALISTS OF MADISON, LLC
Active
Parent organization
DENTAL HEALTH ASSOCIATES OF MADISON LTD
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL HEALTH ASSOCIATES OF MADISON LTD
Authorized official
JAN K STREICH (CLINIC ADMINISTRATOR)
(608) 661-6412
Entity
Organization
Contact information
Practice address
49 N WALBRIDGE AVE., MADISON, WI 53717
(608) 833-2578
(608) 203-7105
Mailing address
2971 CHAPEL VALLEY RD., FITCHBURG, WI 57311-7240
(608) 661-6400
(608) 661-6414
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3628
WI
122300000X
Dentist
6136
WI
122300000X
Dentist
6215
WI
Other
Enumeration date
03/25/2008
Last updated
08/27/2008
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