Provider Demographics
NPI:1679127567
Name:BARDILL DENTAL ASSOCIATES,S.C.
Entity type:Organization
Organization Name:BARDILL DENTAL ASSOCIATES,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARDILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-386-8686
Mailing Address - Street 1:900 6TH ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7172
Mailing Address - Country:US
Mailing Address - Phone:715-386-5888
Mailing Address - Fax:715-386-1648
Practice Address - Street 1:900 6TH ST N STE 200
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-7172
Practice Address - Country:US
Practice Address - Phone:715-386-5888
Practice Address - Fax:715-386-1648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental