Organization
MISHICOT DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON ALLEN THIEL (PRESIDENT / DENTIST)
(920) 755-2336
Entity
Organization
Contact information
Practice address
105 N PARK LN, MISHICOT, WI 54228-9537
(920) 755-2336
Mailing address
105 N PARK LN, MISHICOT, WI 54228-9537
(920) 755-2336
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5096-015
WI
Other
Enumeration date
09/23/2008
Last updated
09/23/2008
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