Organization
ANTIGO DENTAL CLINIC L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MEGHAN K O'BRIEN D.D.S. (PRACTICE OWNER)
(715) 627-4391
Entity
Organization
Contact information
Practice address
707 6TH AVE, ANTIGO, WI 54409
(715) 627-4391
(715) 627-4392
Mailing address
707 6TH AVE, ANTIGO, WI 54409
(715) 627-4391
(715) 627-4392
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5001261-015
WI
Other
Enumeration date
01/04/2007
Last updated
12/14/2016
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