| Dental Park Sc | |
|
1503 Randolph Ct Manitowoc WI 54220-8345 | |
| (920) 682-0321 | |
| (920) 682-3128 |
| Full Name | Dental Park Sc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1503 Randolph Ct, Manitowoc, Wisconsin |
| Authorized Official Name and Position | Daniel Robert Boettcher (PARTNER SECRETARY) |
| Authorized Official Contact | 9206820321 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Park Sc 1503 Randolph Ct Manitowoc WI 54220-8345 Ph: (920) 682-0321 | Dental Park Sc 1503 Randolph Ct Manitowoc WI 54220-8345 Ph: (920) 682-0321 |
| NPI Number | 1386636959 |
|---|---|
| Provider Enumeration Date | 08/18/2005 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386636959 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (Wisconsin) | Primary |
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