Organization
ABC FAMILY DENTAL SERVICES, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN WILLIAM IWEN D.D.S. (PRESIDENT)
(920) 845-2225
Entity
Organization
Contact information
Practice address
613 CENTER DR, LUXEMBURG, WI 54217-1031
(920) 845-2225
(920) 845-5627
Mailing address
613 CENTER DR, LUXEMBURG, WI 54217-1031
(920) 845-2225
(920) 845-5627
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4930 AND 4892
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33740400
—
WI
05
—
33744300
—
WI
Enumeration date
02/21/2007
Last updated
04/15/2009
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