Basic Information
| Provider Information | |||||||||
| NPI: | 1326105230 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DENIS C. SCHARINE, DDS S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 WOLF RIVER DR | ||||||||
| Address2: | P.O. BOX 500 | ||||||||
| City: | FREMONT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549409038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204462213 | ||||||||
| FaxNumber: | 9204462215 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 WOLF RIVER DR | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549409038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204462213 | ||||||||
| FaxNumber: | 9204462215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 11/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | SCHARINE | ||||||||
| AuthorizedOfficialFirstName: | DENIS | ||||||||
| AuthorizedOfficialMiddleName: | CARL | ||||||||
| AuthorizedOfficialTitleorPosition: | DENTIST | ||||||||
| AuthorizedOfficialTelephone: | 9204462213 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 2944 | WI | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 33442600 | 05 | WI | MEDICAID |