Provider Demographics
NPI:1902344989
Name:CHRISTMAN FAMILY DENTAL SC
Entity Type:Organization
Organization Name:CHRISTMAN FAMILY DENTAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-286-2960
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:112 S. STONE STREET
Mailing Address - City:AUGUSTA
Mailing Address - State:WI
Mailing Address - Zip Code:54722
Mailing Address - Country:US
Mailing Address - Phone:715-286-2960
Mailing Address - Fax:
Practice Address - Street 1:112 S STONE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:WI
Practice Address - Zip Code:54722-7221
Practice Address - Country:US
Practice Address - Phone:715-286-2960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty