Wisconsin Dental Group, S.c.

NPI #1164170684 in Franklin, Wisconsin

Provider Information

NPI Number: 1164170684
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: Apr 15, 2022

Practice Location

Address: 7740 S LOVERS LANE RD STE 450
City: Franklin
State: Wisconsin
ZIP Code: 53132-2212
Phone: (414) 963-2301

Authorized Official

Name: CELIA HAYES
Title: CREDENTIALING COORDINATOR
Phone: (217) 540-2100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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