Organization
DIRECT DENTURE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN JOHNSTON (DENTIST)
(608) 518-2859
Entity
Organization
Contact information
Practice address
3000 RILEY RD, SPARTA, WI 54656-6726
(608) 518-2859
(608) 269-6315
Mailing address
3000 RILEY RD, SPARTA, WI 54656-6726
(608) 518-2859
(608) 269-6315
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5752
MN
Other
Enumeration date
10/03/2013
Last updated
10/03/2013
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