Organization
RACINE DENTAL GROUP S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANICE O'LAUGHLIN (HIPAA OFFICER)
(262) 637-9371
Entity
Organization
Contact information
Practice address
1320 S GREENBAY RD, RACINE, WI 53406-4406
(262) 637-9371
Mailing address
1320 S GREENBAY RD, RACINE, WI 53406-4406
(262) 637-9371
(262) 619-7727
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
WI
1223G0001X
General Practice Dentistry
—
WI
1223P0221X
Pediatric Dentistry
—
WI
1223P0300X
Periodontics
—
WI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
WI
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38393900
—
WI
Enumeration date
01/24/2007
Last updated
07/21/2022
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