Grant Park Dental, S.c.
NPI #1578994620 in South Milwaukee, Wisconsin
Provider Information
- NPI Number
- 1578994620
- Entity Type
- Organization
- Organization Name
- Grant Park Dental, S.c.
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Nov 27, 2013
- Last Updated
- Nov 27, 2013
Practice Location
- Address
- 1333 COLLEGE AVE
- Address 2
- SUITE C
- City
- South Milwaukee
- State
- Wisconsin
- ZIP Code
- 53172-1150
- Phone
- (414) 764-6070
Authorized Official
- Name
- DR. MICHAEL COSTELLO, DDS
- Title
- OWNER
- Phone
- (414) 764-6070
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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