Organization
MDC WEST BEND, LLC
Active
Parent organization
MODERN DENTAL CARE HOLDINGS, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MODERN DENTAL CARE HOLDINGS, LLC
Authorized official
MR. BERNARD BOLKA IV (MEMBER)
(920) 579-3188
Entity
Organization
Contact information
Practice address
1625 W PARADISE DR, WEST BEND, WI 53095-7846
(262) 338-2992
Mailing address
7 SHEBOYGAN ST, FOND DU LAC, WI 54935-4281
(920) 579-3188
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5479015
WI
Other
Enumeration date
02/20/2017
Last updated
02/20/2017
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