Individual
DOLORES DIANE PRINCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HYGIENIST
Contact information
Practice address
2405 NORTHWESTERN AVE, RACINE, WI 53404-2534
(262) 886-0474
(262) 886-1672
Mailing address
2405 NORTHWESTERN AVE, RACINE, WI 53404-2534
(262) 886-0474
(262) 886-1672
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
4517-16
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33820400
—
WI
Enumeration date
11/20/2008
Last updated
11/20/2008
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