Organization
MEDFORD DENTAL CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETTY J MISKULIN BOOKKEEPER (SECRETARY)
(715) 678-2215
Entity
Organization
Contact information
Practice address
309 E BROADWAY, MEDFORD, WI 54451
(715) 748-4111
(715) 748-4896
Mailing address
309 E BROADWAY PO BOX 504, MEDFORD, WI 54451
(715) 748-4111
(715) 748-4896
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/27/2006
Last updated
08/22/2020
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