Organization
MOSINEE FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEAH BOUTON (OFFICE MANAGER)
(715) 693-4530
Entity
Organization
Contact information
Practice address
435 ORBITING DR STE A, MOSINEE, WI 54455-1762
(715) 693-4530
Mailing address
435 ORBITING DR STE A, MOSINEE, WI 54455-1762
(715) 693-4530
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
5001639-15
WI
122300000X
Dentist
Primary
5542-15
WI
Other
Enumeration date
02/16/2017
Last updated
02/16/2017
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