Organization
MDC BELLEVUE, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM C MAUTHE III D.D.S. (OWNER)
(920) 921-1244
Entity
Organization
Contact information
Practice address
2040 CENTRAL CT, GREEN BAY, WI 54311-6276
(920) 468-0504
Mailing address
7 SHEBOYGAN ST, FOND DU LAC, WI 54935-4281
(920) 922-8171
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/02/2016
Last updated
03/02/2016
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