Organization
RACINE TOOTH TOWN DENTISTRY FOR KIDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN HENRY KNUTSEN DDS (OWNING DENTIST)
(414) 797-0328
Entity
Organization
Contact information
Practice address
3801 WASHINGTON AVE, RACINE, WI 53405-2853
(414) 949-1938
Mailing address
3801 WASHINGTON AVE, RACINE, WI 53405-2853
(414) 949-1938
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/02/2019
Last updated
07/02/2019
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