Mequonctd1 LLC

NPI #1588249148 in Mequon, Wisconsin

Provider Information

NPI Number: 1588249148
Entity Type: Organization
Organization Name: Mequonctd1 LLC
Primary Specialty: Dentist
Enumeration Date: Mar 16, 2021
Last Updated: Mar 16, 2021

Practice Location

Address: 7604 W MEQUON RD
City: Mequon
State: Wisconsin
ZIP Code: 53097-3215
Phone: (262) 242-8929

Authorized Official

Name: MITCHELL WEILAND
Title: ASSISTANT CONTROLLER
Phone: (608) 343-0818

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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