Mdc West Bend, LLC

NPI #1497294722 in West Bend, Wisconsin

Provider Information

NPI Number: 1497294722
Entity Type: Organization
Organization Name: Mdc West Bend, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: MODERN DENTAL CARE HOLDINGS, LLC
Primary Specialty: Dentist
Enumeration Date: Feb 20, 2017
Last Updated: Feb 20, 2017

Practice Location

Address: 1625 W PARADISE DR
City: West Bend
State: Wisconsin
ZIP Code: 53095-7846
Phone: (262) 338-2992

Authorized Official

Name: MR. BERNARD BOLKA IV
Title: MEMBER
Phone: (920) 579-3188

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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