Organization
SPARTA FAMILY DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALAN DOMEYER D.D.S. (PRESIDENT)
(715) 302-2329
Entity
Organization
Contact information
Practice address
311 JEFFERSON AVE, SPARTA, WI 54656-2113
(608) 269-5008
(608) 269-5018
Mailing address
311 JEFFERSON AVE, SPARTA, WI 54656-2113
(608) 269-5008
(608) 269-5018
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6541-15
WI
Other
Enumeration date
01/18/2016
Last updated
01/18/2016
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