Provider Demographics
NPI:1679795447
Name:ADVANCED DENTAL CARE, S.C.
Entity type:Organization
Organization Name:ADVANCED DENTAL CARE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RIECK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEIERSDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-892-8466
Mailing Address - Street 1:62 S PLEASANTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:WI
Mailing Address - Zip Code:53073-4954
Mailing Address - Country:US
Mailing Address - Phone:920-892-8466
Mailing Address - Fax:920-892-8467
Practice Address - Street 1:62 S PLEASANTVIEW RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-4954
Practice Address - Country:US
Practice Address - Phone:920-892-8466
Practice Address - Fax:920-892-8467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty