Mequon Deer Dental, LLC
Clinic/Center, Dental in Milwaukee, WI. Organization (NPI-2).
NPI number1164047130
StatusActive
Last updated in NPPESJun 15, 2020
Details
- NPI
- 1164047130
- Entity type
- Organization (NPI-2)
- Legal business name
- Mequon Deer Dental, LLC
- Organization subpart
- No
- Enumeration date
- Jun 15, 2020
- Certification date
- Jun 15, 2020
- Last updated
- Jun 15, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
7400 W Brown Deer RdMilwaukee, WI 53223-2078
Phone 414-354-1160
Mailing address
8025 Excelsior DrMadison, WI 53717-1900
Authorized official
Olga Grenova
Dir Of Accounting
6088332213
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