Organization
MERIT DENTAL INC.
Active
Other names
Midwest Dental Freeport
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE MARIE BRION-MARTIN (CREDENTIALING TEAM LEAD)
(715) 598-2311
Entity
Organization
Contact information
Practice address
421 MARKET ST, FREEPORT, PA 16229-1121
(724) 295-5125
(724) 295-5126
Mailing address
680 HEHLI WAY, MONDOVI, WI 54755-1639
(715) 598-2311
(715) 350-6855
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3139-15
WI
Other
Enumeration date
10/19/2017
Last updated
10/19/2017
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