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N84w15959 Appleton Ave Menomonee Falls WI 53051-3044 | |
| (262) 251-6555 | |
| (262) 251-9518 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | N84w15959 Appleton Ave, Menomonee Falls, Wisconsin |
| Authorized Official Name and Position | Brian Anthony Stark (PRESIDENT) |
| Authorized Official Contact | 2622516555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
N84w15959 Appleton Ave Menomonee Falls WI 53051-3044 Ph: (262) 251-6555 | N84w15959 Appleton Ave Menomonee Falls WI 53051-3044 Ph: (262) 251-6555 |
| NPI Number | 1609930627 |
|---|---|
| Provider Enumeration Date | 12/21/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609930627 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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