Organization
DALES BOOTERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JOSEPH HEROLD (MANAGING MEMBER)
(262) 473-4093
Entity
Organization
Contact information
Practice address
155 W MAIN ST, WHITEWATER, WI 53190-1903
(262) 473-4093
(262) 473-4946
Mailing address
155 W MAIN ST, WHITEWATER, WI 53190-1903
(262) 473-4093
(262) 473-4946
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
CPED1589
—
Other
Enumeration date
11/02/2007
Last updated
04/07/2009
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