Wisconsin Dental Group, S.c.

NPI #1760130280 in Glendale, Wisconsin

Provider Information

NPI Number: 1760130280
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: Mar 14, 2022

Practice Location

Address: 500 W SILVER SPRING DR STE K250
City: Glendale
State: Wisconsin
ZIP Code: 53217-5062
Phone: (262) 363-2220

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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