Black Creek Dental Llc | |
207 S Main St Black Creek WI 54106-9742 | |
(920) 984-3315 | |
(920) 984-3317 |
Full Name | Black Creek Dental Llc |
---|---|
Speciality | Dentist - General Practice |
Location | 207 S Main St, Black Creek, Wisconsin |
Authorized Official Name and Position | Thomas E Lornson (OWNER) |
Authorized Official Contact | 9209843315 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Black Creek Dental Llc Po Box 255 Black Creek WI 54106-0255 Ph: (920) 984-3315 | Black Creek Dental Llc 207 S Main St Black Creek WI 54106-9742 Ph: (920) 984-3315 |
NPI Number | 1457716763 |
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Provider Enumeration Date | 12/31/2015 |
Last Update Date | 12/31/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457716763 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 4932-15 (Wisconsin) | Primary |
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