Wauwatosa Dental Group Sc
Dentist in Wauwatosa, WI. Organization (NPI-2).
NPI number1104885482
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1104885482
- Entity type
- Organization (NPI-2)
- Legal business name
- Wauwatosa Dental Group Sc
- Organization subpart
- No
- Enumeration date
- Mar 23, 2006
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | – | – | Yes |
Practice location
2600 N Mayfair RdSuite 750
Wauwatosa, WI 53226-1309
Phone 414-257-3366 · Fax 414-258-1390
Mailing address
2600 N Mayfair RdSuite 750
Wauwatosa, WI 53226-1309
Phone 414-257-3366 · Fax 414-258-1390
Authorized official
John M Dickinson
President Owner
4142573366
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