Organization
BOYS AND GIRLS CLUB OF PORTAGE COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA GUTIERREZ RDH (SMILE CLUB COORDINATOR)
(715) 204-1180
Entity
Organization
Contact information
Practice address
941 MICHIGAN AVE, STEVENS POINT, WI 54481
(715) 204-1180
Mailing address
PO BOX 171, STEVENS POINT, WI 54481
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
10047-16
WI
Other
Enumeration date
11/17/2017
Last updated
11/17/2017
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