Organization
PACK JANESVILLE DENTAL, LLC.
Active
Other names
Aspen Dental
Organization subpart
No
Provider details
NPI number
Authorized official
KIM VAN CAMP (PROVIDER RELATIONS SPECIALIST)
(315) 464-6000
Entity
Organization
Contact information
Practice address
3131 MILTON AVE STE 190, JANESVILLE, WI 53545-0244
(608) 302-4444
(608) 754-4436
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(866) 273-8204
(866) 803-4943
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5001352
WI
Other
Enumeration date
01/19/2015
Last updated
01/19/2015
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