SPARTA DENTAL CENTER SC NPI 1174701676

NPI Information

NPI: 1174701676
Provider Name: SPARTA DENTAL CENTER SC
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

CLIA Number: 52D2190700

Address:
3000 RILEY RD
SPARTA, WI
ZIP 54656
Phone: (608) 269-5282
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SPARTA DENTAL CENTER SC is a dental clinic center in Sparta, WI. SPARTA DENTAL CENTER SC NPI is 1174701676. The provider is registered as an organization entity type.

The provider's business location address is:

3000 RILEY RD
SPARTA, WI
ZIP 54656-588
Phone: (608) 269-5282
Fax: (608) 269-6315

The provider's authorized official is Jennifer L Knoll .
The authorized official title is Owner and has the following contact phone number (608) 269-5282.

The CLIA number assigned to this NPI record is 52D2190700 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/6/2008 and was last updated on 2/6/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental	5770015	WISCONSIN	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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