Edp of Wisconsin, Sc

NPI #1639685779 in Hartland, Wisconsin

Provider Information

NPI Number: 1639685779
Entity Type: Organization
Organization Name: Edp of Wisconsin, Sc
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Dec 27, 2017
Last Updated: Sep 14, 2021

Practice Location

Address: 600 HARTBROOK DR STOP 7
City: Hartland
State: Wisconsin
ZIP Code: 53029-1436
Phone: (262) 367-0680

Authorized Official

Name: MELISSA GARIBAY
Title: CREDENTIALING MANAGER
Phone: (312) 736-8963

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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