Organization
LA CROSSE PEDIATRIC DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN M HANKS DDS (ONWER/DDS)
(608) 782-4054
Entity
Organization
Contact information
Practice address
2 COPELAND AVE STE 203, LA CROSSE, WI 54603-3419
(608) 782-4054
(608) 782-2198
Mailing address
2 COPELAND AVE STE 203, LA CROSSE, WI 54603-3419
(608) 782-4054
(608) 782-2198
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
1001174-15
WI
Other
Enumeration date
03/17/2016
Last updated
03/17/2016
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