Organization
201 WATER FRONT DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL A BENDER DDS (1ST VICE PRESIDENT)
(920) 563-7323
Entity
Organization
Contact information
Practice address
201 SHERMAN AVE. W., FORT ATKINSON, WI 53538
(920) 563-7323
(920) 563-7612
Mailing address
201 SHERMAN AVE. W., FORT ATKINSON, WI 53538
(920) 563-7323
(920) 563-7612
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38366000
—
WI
Enumeration date
08/21/2006
Last updated
11/27/2024
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