Great Lakes Dental, LLC

NPI #1043582869 in Germantown, Wisconsin

Provider Information

NPI Number: 1043582869
Entity Type: Organization
Organization Name: Great Lakes Dental, LLC
Primary Specialty: Dentist
Enumeration Date: Feb 9, 2012
Last Updated: Feb 9, 2012

Practice Location

Address: W188N11927 MAPLE RD
Address 2: SUITE 12
City: Germantown
State: Wisconsin
ZIP Code: 53022-6328
Phone: (262) 509-5755

Authorized Official

Name: MR. ROBERT J GRZYBOWSKI, DDS
Title: OWNER
Phone: (262) 509-5755

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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