Wisconsin Dental Group, S.c.
NPI #1104574623 in Brookfield, Wisconsin
Provider Information
- NPI Number
- 1104574623
- Entity Type
- Organization
- Organization Name
- Wisconsin Dental Group, S.c.
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- WISCONSIN DENTAL GROUP, S.C.
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Mar 14, 2022
- Last Updated
- Mar 14, 2022
Practice Location
- Address
- 15680 W CAPITOL DR
- City
- Brookfield
- State
- Wisconsin
- ZIP Code
- 53005-2221
- Phone
- (262) 373-0344
Authorized Official
- Name
- CELIA HAYES
- Title
- CREDENTIALING COORDINATOR
- Phone
- (217) 540-2100
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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