Wisconsin Dental Group, S.c.

NPI #1992453443 in Mukwonago, Wisconsin

Provider Information

NPI Number: 1992453443
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: Apr 15, 2022

Practice Location

Address: 214 S ROCHESTER ST
City: Mukwonago
State: Wisconsin
ZIP Code: 53149-1612
Phone: (414) 209-0337

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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