Wisconsin Dental Group, S.c.

NPI #1962150417 in Oak Creek, Wisconsin

Provider Information

NPI Number
1962150417
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
7955 S MAIN ST
ZIP Code
53154-1901
Phone
(414) 216-9211

Authorized Official

Name
CELIA HAYES
Title
CREDENTIALING COORDINATOR
Phone
(217) 540-2100

Specialties & Taxonomy Codes

Specialty
Dentist - General PracticeGeneral Practice

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