Organization
MODERN DENTAL CENTER LLC
Active
Other names
Dental Care Alliance
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL COLE (VP INSURANCE PLAN MANAGEMENT)
(727) 424-2990
Entity
Organization
Contact information
Practice address
101 CAMELOT DR STE 3, FOND DU LAC, WI 54935-8048
(920) 921-1244
Mailing address
101 CAMELOT DR STE 3, FOND DU LAC, WI 54935-8048
(920) 921-1244
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
02/25/2022
Last updated
02/25/2022
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