Organization
MDC SUN PRAIRIE LLC
Active
Other names
Westside Dental
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
1460 W MAIN ST, SUN PRAIRIE, WI 53590-1846
(608) 837-4636
Mailing address
54 E 1ST ST, FOND DU LAC, WI 54935-4204
(608) 837-4636
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/01/2015
Last updated
07/01/2015
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