Individual
DR. LARA L DEVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, DDS
Contact information
Practice address
15 E MAIN ST, CHILTON, WI 53014-1427
(920) 849-9341
(920) 849-9342
Mailing address
15 E MAIN ST, PO BOX 71, CHILTON, WI 53014-1427
(920) 849-9341
(920) 849-9342
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6565-15
WI
163W00000X
Registered Nurse
158546-030
WI
Other
Enumeration date
07/19/2010
Last updated
05/20/2019
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