Organization
MENOMONIE STREET DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA ANN HANKE (INSURANCE COORDINATOR)
(715) 834-8161
Entity
Organization
Contact information
Practice address
1020 MENOMONIE ST, EAU CLAIRE, WI 54703-5952
(715) 834-8161
(715) 834-6272
Mailing address
1020 MENOMONIE ST, EAU CLAIRE, WI 54703-5952
(715) 834-8161
(715) 834-6272
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38355800
—
WI
Enumeration date
11/14/2006
Last updated
08/22/2020
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