Organization
FONDY FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD GOEKE DMD (OWNER/DENTIST)
(815) 541-9561
Entity
Organization
Contact information
Practice address
35 W SCOTT ST, FOND DU LAC, WI 54935-2342
(920) 922-2930
Mailing address
35 W SCOTT ST, FOND DU LAC, WI 54935-2342
(920) 922-2930
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285780171
—
WI
05
—
1548619265
—
WI
Enumeration date
12/22/2020
Last updated
12/24/2020
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