Organization
DENTAL PARK SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL ROBERT BOETTCHER DDS (PARTNER SECRETARY)
(920) 682-0321
Entity
Organization
Contact information
Practice address
1503 RANDOLPH CT, MANITOWOC, WI 54220-8345
(920) 682-0321
(920) 682-3128
Mailing address
1503 RANDOLPH CT, MANITOWOC, WI 54220-8345
(920) 682-0321
(920) 682-3128
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
WI
Other
Enumeration date
08/18/2005
Last updated
07/21/2022
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