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Contact Information

FALL CREEK DENTAL
122 STATE ST
FALL CREEK, WI54742
 Phone: 715-877-2113
 Fax: 715-877-3495
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for FALL CREEK DENTAL

NPI Number 1295955342
LBN Legal business name FALL CREEK DENTAL
Authorized official TONY PILGRIM - (DENTIST)
Entity Organization
Organization subpart 1 No
Enumeration date 04/30/2007
Last updated 08/22/2020 - About 6 years ago
Identifiers
WI License # 3104
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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