Great Lakes Dental, Llc

NPI 1043582869 - Dentist - 122300000X

NPI Details
NPI 1043582869
Enumeration Date 02/09/2012
Last Updated 02/09/2012
Entity Type Healthcare Provider
Active Over 4 years ago
Authorized Information
Name ROBERT J ROBERT
Position OWNER
Phone (262) 509-5755
Fax (262) 565-2420
Practice Location
W188N11927 MAPLE RD
SUITE 12
GERMANTOWN WI, 53022-6328, US
Phone (262) 509-5755
Fax (262) 565-2420
Business Location
W188N11927 MAPLE RD
SUITE 12
GERMANTOWN WI, 53022-6328, US
Phone (262) 509-5755
Fax (262) 565-2420
Toxanomy
Taxonomy Code 122300000X
License State Wisconsin
License Number 4018
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According to our database, Great Lakes Dental, Llc NPI is 1043582869, taxonomy code is 122300000X and license number is 4018, license state is located at Wisconsin. Great Lakes Dental, Llc physically located at W188n11927 Maple Rd, Germantown WI, 53022-6328. NPI Number 1033115704 has the healthcare provider type.

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1043582869 NPI number is provided on an as is basis without warranty of any kind. 1043582869 is maintained by the National Plan & Provider Enumeration System. The contents of Great Lakes Dental, Llc are for informational purposes only.