Individual
DR. JACLYN BENISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
311 E TYRANENA PARK RD, LAKE MILLS, WI 53551-9681
(920) 648-2331
(920) 648-3437
Mailing address
311 E TYRANENA PARK RD, LAKE MILLS, WI 53551-9681
(920) 648-2331
(920) 648-3437
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5825
WI
Other
Enumeration date
01/31/2007
Last updated
06/15/2009
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