Comprehensive Dental Services Ltd
Dentist, General Practice in Mequon, WI. Organization (NPI-2).
NPI number1154480002
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1154480002
- Entity type
- Organization (NPI-2)
- Legal business name
- Comprehensive Dental Services Ltd
- Organization subpart
- No
- Enumeration date
- Dec 6, 2006
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 2475-015 | WI | Yes |
Practice location
10521 N Port Washington RdSuite 200
Mequon, WI 53092
Phone 262-241-2060 · Fax 262-241-2064
Mailing address
10521 N Port Washington RdSuite 200
Mequon, WI 53092
Phone 262-241-2060 · Fax 262-241-2064
Authorized official
Marc Jacobson
Vice President
2622412060
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