Organization
CHIPPEWA DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLGA GRENOVA (DIRECTOR OF ACCOUNTING)
(608) 833-2213
Entity
Organization
Contact information
Practice address
405 W PRAIRIE VIEW RD, CHIPPEWA FALLS, WI 54729-3389
(715) 723-7175
Mailing address
405 W PRAIRIE VIEW RD, CHIPPEWA FALLS, WI 54729-3389
(715) 723-7175
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
11/14/2017
Last updated
11/14/2017
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