Organization
WISCONSIN DENTAL GROUP, S.C.
Active
Parent organization
WISCONSIN DENTAL GROUP, S.C.
Other names
ForwardDental Green Bay
Organization subpart
Yes
Provider details
NPI number
Legal business name
WISCONSIN DENTAL GROUP, S.C.
Authorized official
CELIA HAYES (CREDENTIALING COORDINATOR)
(217) 540-2100
Entity
Organization
Contact information
Practice address
1241 LOMBARDI ACCESS RD STE F, GREEN BAY, WI 54304-4059
(920) 498-9088
(920) 498-2146
Mailing address
1241 LOMBARDI ACCESS RD STE F, GREEN BAY, WI 54304-4059
(920) 498-9088
(920) 498-2146
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/06/2007
Last updated
03/14/2022
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