Organization
SUN PRAIRIE FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLGA GRENOVA (DIR OF ACCOUNTING)
(608) 833-2213
Entity
Organization
Contact information
Practice address
180 WILBURN RD, SUN PRAIRIE, WI 53590-1476
(608) 833-2213
Mailing address
8025 EXCELSIOR DR, MADISON, WI 53717-1900
(608) 833-2213
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
12/01/2019
Last updated
12/01/2019
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