Portwashingtonctd1 LLC

NPI #1992396360 in Port Washington, Wisconsin

Provider Information

NPI Number: 1992396360
Entity Type: Organization
Organization Name: Portwashingtonctd1 LLC
Primary Specialty: Dentist
Enumeration Date: Jan 28, 2021
Last Updated: Jan 28, 2021

Practice Location

Address: 222 N FRANKLIN ST
City: Port Washington
State: Wisconsin
ZIP Code: 53074-1903
Phone: (262) 235-4525

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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