Provider Demographics
NPI:1295273050
Name:WALES FAMILY DENTAL
Entity type:Organization
Organization Name:WALES FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-893-0424
Mailing Address - Street 1:482 E WELSH RD
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:WI
Mailing Address - Zip Code:53183-9744
Mailing Address - Country:US
Mailing Address - Phone:614-893-0424
Mailing Address - Fax:
Practice Address - Street 1:300 E SUMMIT AVE
Practice Address - Street 2:SUITE C
Practice Address - City:WALES
Practice Address - State:WI
Practice Address - Zip Code:53183-9664
Practice Address - Country:US
Practice Address - Phone:262-347-4084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6798-15261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental