| Eau Claire Periodontics, L.l.c. | |
|
2125 Heights Dr Ste 2c Eau Claire WI 54701-6146 | |
| (715) 832-5396 | |
| (715) 832-3009 |
| Full Name | Eau Claire Periodontics, L.l.c. |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 2125 Heights Dr Ste 2c, Eau Claire, Wisconsin |
| Authorized Official Name and Position | Jason D. Johnson (CHIEF MANAGER/PERIODONTIST) |
| Authorized Official Contact | 7158325396 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eau Claire Periodontics, L.l.c. 2125 Heights Dr Ste 2c Eau Claire WI 54701-6146 Ph: (715) 832-5396 | Eau Claire Periodontics, L.l.c. 2125 Heights Dr Ste 2c Eau Claire WI 54701-6146 Ph: (715) 832-5396 |
| NPI Number | 1578832853 |
|---|---|
| Provider Enumeration Date | 12/15/2011 |
| Last Update Date | 12/15/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578832853 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 6810-015 (Wisconsin) | Primary |
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