Organization
AHP 007
Active
Other names
Live Life Smiling
Organization subpart
No
Provider details
NPI number
Authorized official
KATE MANTAY (DIRECTOR OF OPERATIONS)
(262) 649-4900
Entity
Organization
Contact information
Practice address
3913 W PROSPECT AVE STE 101, APPLETON, WI 54914-8797
(920) 202-3502
Mailing address
15285 WATERTOWN PLANK RD STE 200, ELM GROVE, WI 53122-2339
(262) 649-4900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/29/2025
Last updated
01/29/2025
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