Organization
WAUSHARA DENTAL ASSOCIATES S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT K BENNOT (PRESIDENT)
(920) 787-3200
Entity
Organization
Contact information
Practice address
N2888 STATE ROAD 22, WAUTOMA, WI 54982-5265
(920) 787-3200
(920) 787-2541
Mailing address
PO BOX 509, WAUTOMA, WI 54982-0509
(920) 787-3200
(920) 787-2541
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/31/2006
Last updated
08/22/2020
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