Provider Demographics
NPI:1447325527
Name:APPLETON FAMILY DENTISTRY SC
Entity type:Organization
Organization Name:APPLETON FAMILY DENTISTRY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOSSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-731-2356
Mailing Address - Street 1:2830 N MASON ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1353
Mailing Address - Country:US
Mailing Address - Phone:920-731-2356
Mailing Address - Fax:920-731-5354
Practice Address - Street 1:2830 N MASON ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-1353
Practice Address - Country:US
Practice Address - Phone:920-731-2356
Practice Address - Fax:920-731-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty