Organization
ALGOMA LAKEVIEW DENTAL CARE, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REBECCA H PRUST D.D.S. (PRESIDENT)
(920) 487-5648
Entity
Organization
Contact information
Practice address
1223 LAKE ST, ALGOMA, WI 54201-1447
(920) 487-5648
(920) 487-5658
Mailing address
1223 LAKE ST, PO BOX 275, ALGOMA, WI 54201-0275
(920) 487-5648
(920) 487-5658
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/30/2012
Last updated
10/30/2012
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