Organization
AWDM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT FONTANA (PRESIDENT)
(315) 454-6000
Entity
Organization
Contact information
Practice address
4113 RIB MOUNTAIN DRIVE, WAUSAU, WI 54401
(715) 359-6060
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(315) 454-6000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/17/2008
Last updated
10/17/2008
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