Provider Demographics
NPI:1538434154
Name:VERONA FAMILY DENTAL LLC
Entity type:Organization
Organization Name:VERONA FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:POPPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-358-3370
Mailing Address - Street 1:271 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1470
Mailing Address - Country:US
Mailing Address - Phone:608-845-6612
Mailing Address - Fax:
Practice Address - Street 1:109 E VERONA AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1218
Practice Address - Country:US
Practice Address - Phone:608-845-6612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPPING STONE DENTAL PARTNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-14
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3838-151223G0001X
WI7275-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty