Organization
BAXA DENTAL INC., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM J. BAXA DDS (OWNER/PRESIDENT)
(715) 985-3316
Entity
Organization
Contact information
Practice address
35791 OSSEO RD, INDEPENDENCE, WI 54747-9096
(715) 985-3316
(715) 985-2542
Mailing address
35791 OSSEO RD, PO BOX 550, INDEPENDENCE, WI 54747-9096
(715) 985-3316
(715) 985-2542
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0003045
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33445800
—
WI
01
—
76993
WPS
WI
Enumeration date
08/08/2006
Last updated
08/22/2020
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