Organization
LIFETIME FAMILY DENTISTRY OF TWO RIVERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY BUCK (OWNER)
(608) 220-1168
Entity
Organization
Contact information
Practice address
1509 19TH ST, TWO RIVERS, WI 54241-2628
(920) 794-8947
(920) 793-8463
Mailing address
1509 19TH ST, TWO RIVERS, WI 54241-2628
(920) 794-8947
(920) 793-8463
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3639015
WI
Other
Enumeration date
04/06/2011
Last updated
04/06/2011
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