Organization
CAMPFIRE PEDIATRIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHANAEL D BENASSI DDS (MEMBER)
(608) 535-9382
Entity
Organization
Contact information
Practice address
8391 GREENWAY BLVD STE 100, MIDDLETON, WI 53562-3544
(815) 979-3837
Mailing address
8391 GREENWAY BLVD STE 100, MIDDLETON, WI 53562-3544
(608) 535-9382
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
09/20/2021
Last updated
04/28/2022
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